The research behind targeted fortification through human milk analysis

Studies show that premature newborns need to consume more protein than full-term babies[i]; in fact, neurodevelopmental outcomes are markedly better in preemies fed human milk fortified with protein[ii], [iii].  Unfortunately, human milk doesn’t contain enough protein to help many preemies catch up to their full-term peers[iv].  Protein supplementation increases short term weight gain and growth of the preemie, both of which not only help the baby regulate their own temperature and leave the NICU sooner, but confer major advantages for later development[v], [vi].

Eating is a difficult and exhausting ordeal for most preemies, which means they can’t get this extra nutrition by consuming a greater volume of milk[vii].  Instead, neonatologists must be able to fortify small amounts of breastmilk or formula to pack more nutritional punch into every feeding.  But how can doctors know the correct level of fortification when there’s no standard nutritional composition for breastmilk?  Even in milk from the same mother, protein levels can vary wildly[viii].

Research suggests that the most effective way to fortify human milk is to analyze each bottle of breastmilk to determine its current composition, then add the exact amount of protein needed[viii].  In 2011, Paragon helped support a study led by MetroHealth Medical Center in Cleveland to explore the accuracy of analyzing the existing nutrients in breastmilk so these customized, fortified feeds could be created.

During the Metro Study, mid-infrared spectroscopy was used to determine the protein composition of each expressed breastmilk sample.  Each feed was fortified based on these readings to ensure every preemie received an accurate feed that didn’t contain too little or too much protein for them to digest.  At the end of the study, infants that were fed using targeted fortification exhibited expected or improved growth rates[viii].  Creating an individualized, targeted fortification plan through human milk analysis is becoming a viable treatment option.

The SafeBaby Team is expanding on this research in order to capitalize on these new techniques and provide a more accurate, safer way to fortify feeds.  In the future, we envision a NICU where every infant receives the exact amount of nutrients they require for optimal growth.  We aim to expand our current tracking and validation feed system to be able to report a comprehensive chemical breakdown of nutrient content of each bottle of breastmilk, donor milk, and supplemented formula feeds.  Once each source has been analyzed, our system would be able to recommend a customized fortification combination for each individual patient.  Read more about our plan to develop SafeNutrition® here.


[i] Review American Academy of Pediatrics Committee on Nutrition: Nutritional needs of low-birth-weight infants. (1985). Pediatrics, 976-986

[ii] Fenton, T. (2014). Higher versus lower protein intake in formula-fed low birth weight infants. Cochrane Database Syst Rev., 4.

[iii] Ayede, D. A. (2011). Achieving Optimal Feeds for Preterm Babies, Recommendations and Realities in Practice: Nigerian Perspective. Annals of Ibadan Postgraduate Medicine, 1-7.

[iv] Lucas, A. (1984). Preterm milk as a source of protein for low birth weight infants. Arch Dis Child, 831–836.

[v] C.A. Kuschel, J. H. (2000). Protein supplementation of human milk for promoting growth in preterm infants. Cochrane Database Syst Rev.

[vi] Lucas, A. (1990). Early diet in preterm babies and developmental status at 18 months. Lancet, 1477-1481.

[vii] Lutz, K. F. (2012). Feeding Problems of NICU and PICU Graduates: Perceptions of Parents and Providers. Newborn Infant Nurs Rev., 207–213.

[viii] Groh-Wargo, S. (2016). Human Milk Analysis Using Mid-Infrared Spectroscopy. Nutr Clin Pract, 266-272.

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