What are the risks of fortifying breast milk?

The Risks of Fortifying Breast Milk: A Closer Look
Fortifying breast milk has gained traction as a method to enhance the nutritional intake of infants, particularly those who are premature or have specific health needs. However, this practice is not without its risks and controversies. As healthcare providers and parents navigate the complexities of infant nutrition, understanding the potential downsides of breast milk fortification is crucial.
Nutritional Imbalance and Variability
One of the primary concerns surrounding breast milk fortification is the risk of nutritional imbalance. Breast milk naturally varies in composition, influenced by factors such as maternal diet, health, and the stage of lactation. When fortifying breast milk, especially for preterm infants, there is a significant risk that the added nutrients may not align with the infant’s specific needs. Research indicates that not accounting for this variability can lead to inappropriate nutritional intake in a substantial number of preterm infants, potentially affecting their growth and development negatively.
Increased Risk of Contamination
Another critical risk associated with fortifying breast milk is the potential for contamination. Many commercial fortifiers, particularly those derived from bovine sources, are not sterile. This lack of sterility raises concerns about introducing harmful bacteria into the breast milk, which can compromise the infant’s health. Studies have shown that bovine-derived fortifiers do not provide the same protective benefits against infections as human milk-derived options, thereby increasing the risk of gastrointestinal infections and other complications.
Gastrointestinal Complications
Fortification can also alter the osmotic pressure of breast milk, which may lead to delayed gastric emptying in infants. This condition can cause discomfort and feeding intolerance, particularly in vulnerable populations such as premature infants. The increased osmotic load from fortified milk can exacerbate these issues, leading to further complications in an already delicate population.
Ethical Considerations and Long-term Health Risks
The choice of fortifier can also raise ethical concerns, particularly when considering the source of the fortifying agents. Some clinicians express apprehension about using cow-milk-derived products due to their association with a higher risk of necrotizing enterocolitis, a severe gastrointestinal condition that can be life-threatening for preterm infants. This has led to a preference for human milk-based fortifiers, which, while safer, come with their own ethical implications regarding sourcing and availability.
Moreover, the long-term health implications of routine fortification are still being studied. While fortification is often necessary for very low birth weight infants to ensure adequate growth, the potential for adverse effects on gut health and immune function remains a topic of ongoing research.
Conclusion
In summary, while fortifying breast milk can provide essential nutrients for infants with increased needs, it is imperative to approach this practice with caution. The risks of nutritional imbalance, contamination, gastrointestinal complications, and ethical dilemmas highlight the need for careful consideration and individualized approaches to infant nutrition. As the conversation around breast milk fortification continues to evolve, ongoing research and dialogue among healthcare providers, parents, and nutritionists will be essential to ensure the best outcomes for vulnerable infants.

Why do hospitals fortify breast milk?

Premature babies need extra protein, fat, vitamins, and minerals to help them grow and build strong bones. In the NICU, we fortify breast milk (add calories, fat, and proteins) to help preemies grow.

Is fortified milk safe?

Fortified milk is a good source of vitamins A and D. Plus, milk is naturally high in several other vitamins and minerals. Both fortified and unfortified milks are highly nutritious.

Does human milk fortifier increase the risk of NEC?

Added value of this study
Hence, our finding, that supplementation with human milk-based fortifier did not affect the primary composite outcome of NEC, sepsis, or mortality in extremely preterm infants, is novel and important information for clinicians in the field of paediatrics.

Is human milk fortifier safe?

Babies usually tolerate it well. On rare occasions, a baby may vomit, pass more stools (poo) or get more constipated. (This often happens even without fortifier, as the gut of premature babies is still immature.) There is no evidence linking fortifier to an increased risk of the bowel infection known as NEC.

What are the disadvantages of fortification?

Elevated Levels of Certain Vitamins & Minerals Can Interact with Prescription Medications. Fortified foods and supplements can pose specific risks for people who are taking prescription medications, including decreased absorption of other micronutrients, treatment failure, and increased mortality risk.

Is it okay to fortify breast milk?

Fortifying any kind of milk – breast or formula – should always be done in consultation with a paediatrician. If done incorrectly, it can lead to dehydration or other side effects (I had to fortify my daughter’s intake due to a medical condition and the dosages were very strictly monitored).

When can I stop fortifying breast milk?

It is generally recommended (5,23) to gradually stop adding breast milk fortifier when the weight, length, and head circumference of gestational age infants are located in P25-P50 of the same gender and age infants, and when the small gestational age premature infants reach P10.

When to stop fortifying breastmilk?

It is generally recommended (5,23) to gradually stop adding breast milk fortifier when the weight, length, and head circumference of gestational age infants are located in P25-P50 of the same gender and age infants, and when the small gestational age premature infants reach P10.

Does NEC cause brain damage?

Although the overall survival of infants after an episode of NEC is about 50% (2), in those children who do survive the initial disease, nearly half will develop profound neurological impairments (10, 11), which are both more severe and more difficult to treat than the brain injuries that develop in premature infants …

What are the side effects of fortifying breast milk?

A potential disadvantage of multi‐nutrient fortification is that increasing nutrient density and osmolarity of human breast milk might interfere with gastric emptying and intestinal peristalsis, resulting in feed intolerance or increasing the risk of necrotising enterocolitis (Ewer 1996; McClure 1996; Gathwala 2008; …