About this Research Topic
Human milk (HM) is the preferred feeding for nearly every newborn. Despite its many advantages, HM does not meet all nutrient needs of the rapidly growing very low birth weight, preterm infant. Protein and minerals are of special concern. Commercial human milk fortifiers and/or preterm formulas are routinely added to HM to increase the nutrient density for preterm infants. Current clinical practice generally assumes a uniform composition of HM when calculating nutrient intake of infants in the neonatal intensive care unit (NICU).
However, the nutritional composition of HM is known to be highly variable based on several factors including the length of gestation, stage of lactation, maternal factors including diet, BMI and genetics, pumping techniques and storage of expressed milk, and method of feeding. Without a known nutrient profile of the expressed HM fed to a baby, the composition of the feeding is only an estimate. The term `lactoengineering' has been coined to describe ways to individualize human milk feeding and fortification. Two approaches of interest are ‘adjustable fortification’ and ‘targeted fortification'. These strategies, along with other methods such as collection of hindmilk and production of skimmed milk, can operationalize an individualized approach to feeding HM. Bedside nutrient analysis of human milk is necessary to incorporate `targeted fortification' into clinical care and has the potential to revolutionize the approach to fortification. This is a practice change for many, however, and requires special equipment, personnel, and knowledge to be successful. Ultimately, the goal of lactoengineering is to encourage the feeding of HM while meeting known nutritional requirements.
This Research Topic will present interesting case studies and case series, results of original research, surveys of contemporary clinical practice, and both narrative reviews and systematic reviews/meta-analyses of relevant topics. The unifying goal is to improve nutritional status and growth, and longterm developmental outcomes of human milk-fed preterm, very low birth weight newborns through the use of lactoengineering.
However, the nutritional composition of HM is known to be highly variable based on several factors including the length of gestation, stage of lactation, maternal factors including diet, BMI and genetics, pumping techniques and storage of expressed milk, and method of feeding. Without a known nutrient profile of the expressed HM fed to a baby, the composition of the feeding is only an estimate. The term `lactoengineering' has been coined to describe ways to individualize human milk feeding and fortification. Two approaches of interest are ‘adjustable fortification’ and ‘targeted fortification'. These strategies, along with other methods such as collection of hindmilk and production of skimmed milk, can operationalize an individualized approach to feeding HM. Bedside nutrient analysis of human milk is necessary to incorporate `targeted fortification' into clinical care and has the potential to revolutionize the approach to fortification. This is a practice change for many, however, and requires special equipment, personnel, and knowledge to be successful. Ultimately, the goal of lactoengineering is to encourage the feeding of HM while meeting known nutritional requirements.
This Research Topic will present interesting case studies and case series, results of original research, surveys of contemporary clinical practice, and both narrative reviews and systematic reviews/meta-analyses of relevant topics. The unifying goal is to improve nutritional status and growth, and longterm developmental outcomes of human milk-fed preterm, very low birth weight newborns through the use of lactoengineering.
Keywords: human milk, preterm, very low birth weight, human milk fortification, growth
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