(LB02-13-25) Donor Human Milk When Used With or Without Human Milk Fortifiers Fails To Meet Preterm Infant Nutrient Recommendations

Objectives: In line with the aims of the Global Donor Human Milk Composition Study, we sought to characterize the macronutrients, vitamins, and minerals in unfortified and fortified donor human milk (DHM) and compare to nutrient recommendations for the preterm infant.

Methods: Human milk from 400 approved milk bank donors in the United States, collected from four milk banks in the Human Milk Bank Association of North America network, served as the sampling frame. Macronutrients, vitamins, and minerals were assessed using validated methods appropriate for human milk. We simulated creating 1000 pools of DHM by randomly combining the milk of five donors. Human milk fortifier (HMF) products available in the United States were identified and used to compute the final nutrients delivered with fortified DHM at full feeds of 160 ml/kg/day, which we compared to recommendations from the European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) for preterm infants.

Results: We evaluated 12 HMF products including those derived from human and bovine milk. When mixed according to HMF manufacturer’s instructions, final nutrient concentrations in DHM ranged from 50% to > 11,000% of the unfortified values. Unfortified DHM was rarely/never able to meet the lower ESPGHAN target for 18 of the 21 measured nutrients. Lower ESPGHAN recommendations for vitamins were met with bovine-derived fortifiers, but not with human-derived fortifiers, while protein and energy targets were met (and sometimes exceeded) with human-derived fortifiers, but not with bovine-derived fortifiers. Several minerals (copper, iron, selenium, zinc) were not met with the bovine-derived fortifiers, while some minerals (calcium, magnesium, phosphorus) exceeded upper ESPGHAN targets with the human-derived fortifiers.

Conclusions: Current fortifier products available in the US increase the concentration of most nutrients in DHM, though the increase varies widely between nutrients. No fortifier products evaluated in this study could adequately reach ESPGHAN targets for macronutrients, vitamins, and minerals, when used with DHM, suggesting that a fortifier designed uniquely for DHM is warranted.

Funding Sources: Supported by funding from the Eunice Kennedy Shriver National Institute of Child Health and Human Development.