How appropriate are commercially available human milk fortifiers?

A preliminary investigation was made into the effectiveness of two breastmilk fortifiers on the Australian market (FM‐85 [Nestle, Vevey, Switzerland] and Enfamil Human Milk Fortifier [EHMF; Mead Johnson, Evansville, IN, USA]). Infants < 1800 g and < 34 weeks gestation at birth, who were receiving breast milk, were randomized to receive either of the fortifiers (n= 14 for FM‐85, n= 10 for EHMF), until a weight of 2 kg was reached. Infants not receiving breast milk (n= 9) were fed a preterm formula (Prenan, Nestlé). The two fortifier groups were similar in most parameters examined: (i) weight gain (17.9 ± 3.0 vs 17.4 ± 3.5g/kg per day); (ii) head circumference growth (1.02 ± 0.28 vs 1.03 ± 0.25 cm/week); (iii) arm muscle area growth (32.6 ± 20.0 vs 33.5 ± 13.7 mm²/week); (iv) arm fat area growth (14.3 ± 6.1 vs 14.0 ± 8.7 mm²/week); (v) plasma calcium (2.52 ± 0.08 vs 2.58 ± 0.15 mmol/L); (vi) plasma phosphate (2.02 ± 0.21 vs 2.13 ± 0.32 mmol/L); (vii) plasma copper (5.28 ± 2.83 vs 5.66 ± 3.07 pmol/L); and (vii) plasma zinc (13.3 ± 5.5 vs 15.8 ± 9.2 μmol/L). The FM‐85 group had a higher alkaline phosphatase level (355 ± 110 vs 231 ± 70 iu/L) than the EHMF group; however, no values were outside the normal range. The Prenan group had a higher rate of weight gain (23.6 ± 3.3 g/kg per day) and higher arm fat area growth rate (25.2 ± 7.6 mm²/week) than the fortifier groups, while all other parameters were similar. The incidence of feed intolerance was considered high in both fortifier groups. The addition of many of the components of breastmilk fortifiers has not been well validated and it is proposed that a simplified fortifier composed of protein and phosphate may be better tolerated and equally effective at optimizing growth and bone mineralization. The specific needs of extremely low birthweight infants (>1000 g) have not been addressed.