Biological and Nutritional Aspects of Human Milk in Feeding of Preterm Infants


Breastfeeding and human milk are the normative standards for feeding and nutrition of both term and pre-term infants. Fresh mother’s own milk is recognized as the optimal choice for feeding all newborns, including preterm and very low birth weight infants. Evidence documents short and long-term metabolic, immunologic and neurodevelopmental advantages of breastfeeding when compared to formula. Moreover, benefits of breastfeeding on psychological and relational aspects have to be considered. Currently, human milk supplementation is usually performed to meet the specific nutritional requirements of preterm infants. When mother’s milk is unavailable or in short supply, donor milk represents the best alternative, although some nutritional elements are inactivated by the necessary pasteurization process. Aim of this review is to briefly summarize the main biological and nutritional factors that contribute to the beneficial effects of human milk feeding for preterm infants.

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M. Giribaldi, L. Cavallarin, C. Baro, P. Di Nicola, A. Coscia and E. Bertino, "Biological and Nutritional Aspects of Human Milk in Feeding of Preterm Infants," Food and Nutrition Sciences, Vol. 3 No. 12, 2012, pp. 1682-1687. doi: 10.4236/fns.2012.312220.

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The authors declare no conflicts of interest.


[1] American Academy of Pediatrics, “Breastfeeding and Use of Human Milk,” Pediatrics, Vol. 129, No. 3, 2012, pp. e827-e841. doi: 10.1542/peds.2011-3552
[2] S. Arslanoglu, et al., “Guidelines for the Establishment and Operation of a Donor Human Milk Bank,” Journal of Maternal-Fetal and Neonatal Medicine, Vol. 23, No. 2, 2010, pp. 1-20. doi:10.3109/14767058.2010.512414
[3] C. Agostoni, et al., “Enteral Nutrient Supply for Preterm Infants: Commentary from the European Society of Paediatric Gastroenterology, Hepatology and Nutrition Committee on Nutrition”, Journal of Pediatric Gastroenterology and Nutrition, Vol. 50, No. 1, 2010, pp. 85-91. doi:10.1097/MPG.0b013e3181adaee0
[4] C. A. Kuschel and J. E. Harding, “Multicomponent Fortified Human Milk for Promoting Growth in Preterm Infants,” Cochrane Database of Systematic Reviews (Online), No. 1, 2004. doi:10.1002/14651858.CD000343.pub2
[5] S. Arslanoglu, G. E. Moro and E. E. Ziegler, “Optimization of Human Milk Fortification for Preterm Infants: New Concepts and Recommendations,” Journal of Perinatal Medicine, Vol. 38, No. 3, 2010, pp. 233-238. doi:10.1515/jpm.2010.073
[6] C. Di Natale, E. Coclite, L. Di Ventura and S. Di Fabio, “Fortification of Maternal Milk for Preterm Infants,” Journal of Maternal-Fetal and Neonatal Medicine, Vol. 24, No. 1, 2011, pp. 41-43. doi:10.3109/14767058.2011.607569
[7] E. Bertino, et al., “Benefits of Donor Human Milk for Preterm Infants: Current Evidence,” Early Human Development, Vol. 85, No. 10, 2009, pp. S9-S10. doi:10.1016/j.earlhumdev.2009.08.010
[8] W. McGuire, “Donor Human Milk for Preterm Infants,” Pediatrics, Vol. 130, No.2, 2012, p. e462. doi:10.1542/peds.2012-1647C
[9] S. Arslanoglu, E. E. Ziegler and G. E. Moro, “Donor Human Milk in Preterm Infant Feeding: Evidence and Recommendations,” Journal of Perinatal Medicine, Vol. 38, No. 4, 2010, pp. 347-351. doi:10.1515/jpm.2010.064
[10] M. F. Picciano, “Nutrient Composition of Human Milk,” Pediatric Clinics of North America, Vol. 48, No. 1, 2001, pp. 53-67. doi:10.1016/S0031-3955(05)70285-6
[11] L. A. Hanson, M. Korotkova and E. Telemo, “Breastfeeding, Infant Formulas, and the Immune System,” Annals of Allergy, Asthma and Immunology, Vol. 90, No. 6, 2003, pp. 59-63. doi:10.1016/S1081-1206(10)61662-6
[12] S. Fanaro and V. Vigi, “Feeding the Term Infant: Human Milk and Formula,” In: G. Buonocore, R. Bracci and M. Weindling, Eds., Neonatology. A Practical Approach to Neonatal Diseases: A Practical Approach to Neonatal Management, Springer, Milan, 2012, pp. 290-297. doi:10.1007/978-88-470-1405-3_44
[13] B. L?nnerdal, “Nutritional and Physiologic Significance of Human Milk Proteins,” American Journal of Clinical Nutrition, Vol. 77, No. 6, 2003, 1537S-1543S.
[14] S. Mills, R. P. Ross, C. Hill, G. F. Fitzgerald and C. Stanton, “Milk Intelligence: Mining Milk for Bioactive Substances Associated with Human Health,” International Dairy Journal, Vol. 21, No. 6, 2011, pp. 377-401. doi:10.1016/j.idairyj.2010.12.011
[15] F. Michetti, et al., “The S100B Protein in Biological Fluids: More than a Lifelong Biomarker of Brain Distress,” Journal of Neurochemistry, Vol. 120, No. 5, 2012, pp. 644-659. doi:10.1111/j.1471-4159.2011.07612.x
[16] C. Ballabio, et al., “Immunoglobulin—A Profile in Breast Milk from Mothers Delivering Full Term and Preterm Infants,” International Journal of Immunopathology and Pharmacology, Vol. 20, No. 1, 2007, pp. 119-128.
[17] G. E. Moro and S. Arslanoglu, “Heat Treatment of Human Milk,” Journal of Pediatric Gastroenterology and Nutrition, Vol. 54, No. 2, 2012, pp. 165-166. doi:10.1097/MPG.0b013e318235d629
[18] C. E. Molinari, et al., “Proteome Mapping of Human Skim Milk Proteins in Term and Preterm Milk,” Journal of Proteome Research, Vol. 11, No. 3, 2012, pp. 1696-1714. doi:10.1021/pr2008797
[19] S. Fanaro, et al., “Galacto-Oligosaccharides Are Bifidogenic and Safe at Weaning: A Double-Blind Randomized Multicenter Study,” Journal of Pediatric Gastroenterology and Nutrition, Vol. 48, No. 1, 2009, pp. 82-88. doi:10.1097/MPG.0b013e31817b6dd2
[20] L. Bode, “Human Milk Oligosaccharides: Every Baby Needs a Sugar Mama,” Glycobiology, Vol. 22, No. 9, 2012, pp. 1147-1162. doi:10.1093/glycob/cws074
[21] C. Kunz, S. Rudloff, W. Baier, N. Klein and S. Strobel, “Oligosaccharides in Human Milk: Structural, Functional, and Metabolic Aspects,” Annual Reviews of Nutrition, Vol. 20, 2000, pp. 699-722. doi:10.1146/annurev.nutr.20.1.699
[22] G. Boehm and B. Stahl, “Oligosaccharides from Milk,” Journal of Nutrition, Vol. 137, No. 3, 2007, pp. 847S-849S.
[23] S. Thurl, J. Henker, M. Siegel, K. Tovar and G. Sawatzki, “Detection of Four Human Milk Groups with Respect to Lewis Blood Group Dependent Oligosaccharides,” Glycoconjugate Journal, Vol. 14, No. 7, 1997, pp. 795-799. doi:10.1023/A:1018529703106
[24] O. Gabrielli, et al., “Preterm Milk Oligosaccharides during the First Month of Lactation,” Pediatrics, Vol. 128, No. 6, 2011, pp. e1520-e1531. doi:10.1542/peds.2011-1206
[25] M. B. Heyman, “Lactose Intolerance in Infants, Children, and Adolescents”, Pediatrics, Vol. 118, No. 3, 2006, pp. 1279-1286. doi:10.1542/peds.2006-1721
[26] S. Perrone, G. Salvi, C. V. Bellieni and G. Buonocore, “Oxidative Stress and Nutrition in the Preterm Newborn,” Journal of Pediatric Gastroenterology and Nutrition, Vol. 45, No. 4, 2007, pp. S178-S182. doi:10.1097/01.mpg.0000302968.83244.d2
[27] A. Tsopmo and J. K. Friel, “Human Milk has Anti-Oxidant Properties to Protect Premature Infants,” Current Pediatric Reviews, Vol. 3, No. 1, 2007, pp. 45-51. doi:10.2174/157339607779941615
[28] J. K. Friel, S. M. Martin, M. Langdon, G. R. Herzberg and G. R. Buettner, “Milk from Mothers of Both Premature and Full-Term Infants Provides Better Antioxidant Protection than Does Infant Formula,” Pediatric Research, Vol. 51, No. 5, 2002, pp. 612-618. doi:10.1203/00006450-200205000-00012
[29] N. Hanna, K. Ahmed, M. Anwar, A. Petrova, M. Hiatt and T. Hegyi, “Effect of Storage on Breast Milk Antioxidant Activity,” Archives of Disease in Childhood: Fetal and Neonatal Edition, Vol. 89, No. 6, 2004, pp. F518-F520. doi:10.1136/adc.2004.049247
[30] M. C. Michalski, C. Calzada, A. Makino, S. Michaud and M. Guichardant, “Oxidation Products of Polyunsaturated Fatty Acids in Infant Formulas Compared to Human Milk —A Preliminary Study,” Molecular Nutrition and Food Research, Vol. 52, No. 12, 2008, pp. 1478-1485.
[31] E. Granot, D. Golan, L. Rivkin and R. Konen, “Oxidative Stress in Healthy Breast Fed versus Formula Fed Infants,” Nutrition Research, Vol. 19, No. 6, 1999, pp. 869-879. doi:10.1016/S0271-5317(99)00047-0
[32] D. Turoli, G. Testolin, R. Zanini and R. Bellù, “Determination of Oxidative Status in Breast and Formula Milk,” Acta Paediatrica, International Journal of Paediatrics, Vol. 93, No. 12, 2004, pp. 1569-1574. doi:10.1111/j.1651-2227.2004.tb00845.x
[33] O. Korchazhkina, E. Jones, M. Czauderna and S. A. Spencer, “Effects of Exclusive Formula or Breast Milk Feeding on Oxidative Stress in Healthy Preterm Infants,” Archives of Disease in Childhood, Vol. 91, No. 4, 2006, pp. 327-329. doi:10.1136/adc.2005.084798
[34] M. De Curtis and J. Rigo, “The Nutrition of Preterm Infants,” Early Human Development, Vol. 88, No. 1, 2012, pp. S5-S7. doi:10.1016/j.earlhumdev.2011.12.020
[35] F. M. McCormick, G. Henderson, T. Fahey and W. McGuire, “Multinutrient Fortification of Human Breast Milk for Preterm Infants Following Hospital Discharge,” Cochrane Database of Systematic Reviews (Online), Vol. 7, 2010. doi:10.1002/14651858.CD004866.pub3
[36] L. Corvaglia, et al., “Standard Fortification of Preterm Human Milk Fails to Meet Recommended Protein Intake: Bedside Evaluation by Near-Infrared-Reflectance-Analysis,” Early Human Development, Vol. 86, No. 4, 2010, pp. 237-240. doi:10.1016/j.earlhumdev.2010.04.001
[37] S. E. Carlson, S. H. Werkman, J. M. Peeples, R. J. Cooke and E. A. Tolley, “Arachidonic Acid Status Correlates with First Year Growth in Preterm Infants,” Proceedings of the National Academy of Sciences of the United States of America, Vol. 90, No. 3, 1993, pp. 1073-1077. doi:10.1073/pnas.90.3.1073
[38] M. Neuringer, G. J. Anderson and W. E. Connor, “The Essentiality of N-3 Fatty Acids for the Development and Function of the Retina and Brain,” Annual Review of Nutrition, Vol. 8, 1988, pp. 517-541. doi:10.1146/annurev.nutr.8.1.517
[39] M. Fleith and M. T. Clandinin, “Dietary PUFA for Preterm and Term Infants: Review of Clinical Studies,” Critical Reviews in Food Science and Nutrition, Vol. 45, No. 3, 2005, pp. 205-229. doi:10.1080/10408690590956378
[40] M. Hadders-Algra, “Prenatal and Early Postnatal Supplementation with Long-Chain Polyunsaturated Fatty Acids: Neurodevelopmental Considerations,” American Journal of Clinical Nutrition, Vol. 94, No. 6, 2011, pp. 1874S1879S. doi:10.3945/ajcn.110.001065
[41] C. Moltó-Puigmartí, A. I. Castellote, X. Carbonell-Estrany and M. C. López-Sabater, “Differences in Fat Content and Fatty Acid Proportions among Colostrum, Transitional, and Mature Milk from Women Delivering Very Preterm, Preterm, and Term Infants,” Clinical Nutrition, Vol. 30, No. 1, 2011, pp. 116-123. doi:10.1016/j.clnu.2010.07.013
[42] W. W. Hay Jr., “Strategies for Feeding the Preterm Infant,” Neonatology, Vol. 94, No. 4, 2008, pp. 245-254. doi:10.1159/000151643
[43] C. Kunz and B. L?nnerdal, “Re-Evaluation of the Whey Protein/Casein Ratio of Human Milk,” Acta Paediatrica, Vol. 81, No. 2, 1992, pp. 107-112. doi:10.1111/j.1651-2227.1992.tb12184.x
[44] E. Bertino, et al., “Effect of Prolonged Refrigeration on the Lipid Profile, Lipase Activity and Oxidation Status of Human Milk,” Journal of Pediatric Gastroenterology and Nutrition, in Press. doi:10.1097/MPG.0b013e31827af155
[45] B. L?nnerdal, R. Jiang and X. Du, “Bovine Lactoferrin Can Be Taken up by the Human Intestinal Lactoferrin Receptor and Exert Bioactivities,” Journal of Pediatric Gastroenterology and Nutrition, Vol. 53, No. 6, 2011, pp. 606-614. doi:10.1097/MPG.0b013e318230a419
[46] Human Milk Banking Association of North America (HMBANA), “Guidelines for the Establishment and Operation of a Donated Human Milk Bank,” Sandwich, MA, HMBANA, 2009.
[47] B. T. Hartmann, W. W. Pang, A. D. Keil, P. E. Hartmann and K. Simmer, “Best Practice Guidelines for the Operation of a Donor Human Milk Bank in an Australian NICU,” Early Human Development, Vol. 83, No. 10, 2007, pp. 667-673. doi:10.1016/j.earlhumdev.2007.07.012
[48] C. Baro, et al., “Effect of Two Pasteurization Methods on the Protein Content of Human Milk,” Frontiers in Bioscience, Vol. 3, 2011, pp. 818-829. doi:10.2741/289
[49] C. A. Boyd, M. A. Quigley and P. Brocklehurst, “Donor Breast Milk versus Infant Formula for Preterm Infants: Systematic Review and Meta-Analysis,” Archives of Disease in Childhood: Fetal and Neonatal Edition, Vol. 92, No. 3, 2007, pp. F169-F175. doi:10.1136/adc.2005.089490
[50] M. A. Quigley, G. Henderson, M. Y. Anthony and W. McGuire, “Formula Milk versus Donor Breast Milk for Feeding Preterm or Low Birth Weight Infants,” Cochrane Database of Systematic Reviews (Online), No. 4, 2007. doi:10.1002/14651858.CD002971.pub2
[51] W. McGuire and M. Y. Anthony, “Donor Human Milk versus Formula for Preventing Necrotising Enterocolitis in Preterm Infants: Systematic Review,” Archives of Disease in Childhood: Fetal and Neonatal Edition, Vol. 88, No. 1, 2003, pp. F11-F14. doi:10.1136/fn.88.1.F11
[52] N. Modi, “Donor breast milk banking”, British Medical Journal, Vol. 333, No. 7579, 2006, pp. 1133-1134. doi:10.1136/bmj.39034.651563.80
[53] E. Bertino, F. Giuliani, C. Peila, P. Di Nicola, C. Vassia and S. Arslanoglu, “Benefit of Donor Human Milk in Preterm Infant Feeding,” Eaaarly Human Development, Vol. 85, No. 10, 2012, pp. S9-S10. doi:10.1016/j.earlhumdev.2009.08.010
[54] M. J. Renfrew, et al., “Breastfeeding Promotion for Infants in Neonatal Units: A Systematic Review,” Child: Care, Health and Development, Vol. 36, No. 2, 2010, pp. 165-178. doi:10.1111/j.1365-2214.2009.01018.x
[55] [55] R. Davanzo, L. Monasta, L. Ronfani, P. Brovedani and S. Demarini, “Breastfeeding at NICU Discharge: A Multi-center Italian Study,” Journal of Human Lactation, 2012, in Press. doi:10.1177/0890334412451055

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