1398 Effect of Fortifiers and Additional Protein on the Osmolarity of Human Milk- is it Safe for the Premature Infant?. (October 2012) - Haiden, N
Abstract : Background and Aims: A new additional protein supplement (Aptamil Protein+®/Milupa) was developed to meet special protein requirements of infants with a birthweight below 1000g (4.0–4.5 g protein/kg/day). So far it was unknown, how this new protein supplement influences osmolarity, which is known to be a risk factor for necrotising enterocolitis (NEC). The aim of this study was to evaluate the effects of fortification on the osmolarity of human milk (HM). Methods: Osmolarity of breast milk was measured in native HM, in HM+ HMF (human milk fortifier; Aptamil FMS 4.3%®, Milupa) and in HM+ HMF+ Protein+ gaining in 0.5 g steps up to 4 g. Measurements were performed immediately after adding on fortifier and/or protein and after 24 hours. In addition, changes in osmolarity after adding therapeutic additives like iron (Ferrum Hausmann®, Vifor), multivitamine supplement (Protovit®, Bayer) and calcium-phosphorus capsules were measured. Results: Osmolarity of native human milk (n=84) was 297mosm/l, (=Median, Range 278–348). Adding HMF increased osmolarity up to 436mosm/l (=Median; Range 386–486). Additional Protein+ supplementation increased osmolarity by 23.5mosm/l (Median) per 0.5g step, up to a maximum of 605 mosm/l (+4g). Osmolarity of HM/fortifier/Protein+ mixes remained stable for 24 hours. Multivitamin supplements increased osmolarity up to 842mosm/l. Discussion: Additional Protein+ increased osmolarity of HM up to a critical cut off point (>400mosmol) and therefore might be a risk factor for developing NEC. Additional fortification of HM +HMF with Protein+ should not be applied together with multivitamins or other additives.