!["The study reinforces what many in the industry, medical, and scientific community already support: probiotics play a crucial role in reducing mortality in preterm infants, [and] strengthens the case for probiotic supplementation as a standard of care in neonatal units," said Paraskevakos.](https://www.nutraingredients.com/resizer/v2/L2LGB2JR7ZCONCVFMD5SJMGXXA.jpg?auth=a31d33782493600611cebcab92aa9fe633a4cbc8477f5f1d071848e02034bdf9&width=824&height=465&smart=true)
Researchers in Israel compared the effects of exclusive mother’s own milk (MOM) feeding, MOM plus donor human milk (DHM), and MOM plus preterm formula on bone metabolism markers, growth and clinical outcomes in very preterm and VLBW infants.
“Both DHM and preterm formula are viable supplements to MOM, ensuring nutritional adequacy without adverse bone health effects,” the researchers reported.
Bone health risks in preterm infants
Bone mineral deficiency affects 23% to 50% of very low birth weight (VLBW) and extremely low birth weight (ELBW) infants and can often persist into childhood.
When MOM is unavailable or insufficient, DHM is often the recommended alternative over preterm formula: The World Health Organization currently recommends DHM as the first alternative to MOM for preterm infants born before 32 weeks or weighing under 1.5 kg (3.3 lb).
However, DHM differs from MOM because donor lactation stage and pasteurization reduce its nutritional, immune and bioactive properties.
Formula feeding supports faster weight and linear growth than DHM but may also increase the risk of NEC because of how it interacts with the immature gut of premature babies.
Preterm and VLBW infants also face a high risk of low bone mineral content and metabolic bone disease as they miss the mineral accretion of the third trimester. Adequate calcium, phosphorus and vitamin D intake is critical to prevent osteopenia and support bone health.
Formula-supplemented breast milk may support bone health in preterm infants
The researchers reviewed medical records of 263 very preterm infants and VLBW infants born between Jan. 1, 2018 and June 30, 2023. Among them, 135 received exclusive MOM, 54 received MOM plus formula and 74 received MOM plus DHM.
They measured biochemical markers of bone metabolism, including alkaline phosphatase, phosphorus and calcium, at baseline and on days seven, 14 and 28 of life.
Results showed that infants fed with MOM and DHM had the highest bone enzyme, alkaline phosphatase (ALKP), levels on day seven, which can be a sign of weaker bone mineralization. By day 14, MOM-fed infants showed higher ALKP levels than those given MOM and formula. MOM-fed infants also had lower phosphorus levels on day 14 than both mixed feeding groups. However, by day 28, all groups had similar bone marker levels.
The researchers explained that DHM may lower NEC risk but provides fewer nutrients, such as protein, sodium, chloride, potassium and zinc than preterm milk, emphasizing the need for fortification.
Supplementing MOM with formula did not increase NEC risk.
“These findings suggest that both DHM and preterm formula are viable supplements to MOM when needed, supporting nutritional adequacy without adverse effects on bone health,” the researchers concluded.
They added that future research is needed to evaluate the long-term impacts of these feeding strategies on growth, bone health and neurodevelopmental outcomes in very preterm infants.
Source: Nutrients. doi: 10.3390/nu17203263. “Effects of Donor Human Milk and Formula Supplementation on Bone Metabolism and Clinical Outcomes in Preterm Infants Receiving Mother’s Own Milk”. Authors: Herzlich, J. et al.
