Fortified breast milk best for premature infants

Premature infants fed breast milk fortified with extra nutrients fare better than those receiving special preterm formulas, according to results of a large-scale study from the USDA/ARS Children's Nutrition Research Center.

"Of all the feeding strategies tested, the factor that influenced premature infant health the most was fortified human milk," said Dr. Richard Schanler, a professor of pediatrics at Baylor College of Medicine in Houston.

In the study, 108 infants born between 11 and 13 weeks premature, and weighing less than two and one-half pounds each, were fed either a special preterm formula or fortified breast milk, depending on parental wishes. Within each group, milk feedings were initiated at different times and the tube-feeding method was varied to determine an optimal feeding regimen.

Although differences were expected, researchers were impressed that feeding fortified human milk was the hands-down winner--regardless of feeding method. 

According to Schanler, the infants who received fortified human milk "graduated" from intravenous to milk feedings faster and had fewer of the complications common in premature infants. They experienced less sepsis, or infections in the blood, and had fewer cases of necrotizing enterocolitis, an intestinal inflammation that often requires surgery. They also needed less medication to control spitting up and were discharged from the hospital an average of two weeks sooner than their formula-fed counterparts.

"Breast milk contains antibodies and other important substances that encourage the growth of 'good' bacteria in an infant's intestinal tract and also inhibit the growth of harmful ones that can invade an infant's system and cause problems," Schanler said.

"But, human milk fed to premature infants must first be fortified with additional protein and minerals like calcium and phosphorus," he said. Before these extra nutrients were added to formulas or incorporated into fortifiers for human milk, premature infants grew poorly and developed bones that fractured easily.

"Although fortified human milk feedings might also need to be supplemented with preterm formula, all efforts by a mother to provide her milk should be supported," Schanler said. "Every teaspoon of human milk contains protective benefits."

Editor's Note: This study appeared in the June, 1999 issue of Pediatrics.