Synopsis
Introduction
Human milk provides the optimal nutrition for term infants. Human milk is also recommended for preterm infants, but does not alone provide optimal nutrition. The growth and neurodevelopmental needs of the evolutionarily new population of very premature infants are best met by appropriate fortification of human milk. To explore the role of human milk in the care of premature infants, it is appropriate to begin with a comparison of amniotic fluid (the optimal beverage of the fetus), milk from mothers delivering preterm, and milk from mothers delivering at term. We will then consider the benefits and challenges of providing human milk to premature infants, approaches to human milk fortification, the advantages and challenges of donor human milk products, and finally some practical approaches to increasing human milk consumption in premature infants.
In the United States, approximately 12% of infants are born preterm (prior to 37 weeks gestation).1 This is a very heterogeneous population with widely diverse nutritional requirements and highly different stages of immunocompetence. A 2.5 kg neonate born at 34 weeks gestation differs from a 500 gram neonate born at 24 weeks gestation in essentially every physiologic aspect of the gastrointestinal system and the innate and adaptive immune systems. Consequently the current body of knowledge about nutrition and host defense of premature infants has many gaps. Studies performed on larger older premature infants may not be applicable to the extremely low birth weight infants (ELBW,