4. Discussion
milk, breast milk analyzer, preterm donor milk, VLBW, human milk fortification, breast milk, Dritsakou
GROWTH RETARDATION, GROWTH FAILURE
Optimal growth of VLBW infants is a primary goal in NICU but not easy to achieve. Growth failure was observed in 80% of VLBW infants in studies conducted under the Neonatal Research Network between 2008 and 2010 [In this study, the composition of milk was accurately measured using a human milk analyzer (Miris HMA); the analyzer was used to capture the exact composition of MOM and DM at set time intervals. Miris HMA was not used as a tool for individualized fortification since breast milk samples in both groups were similarly fortified per manufacturer guidelines and regardless of measured protein concentration in order to fulfill the goals of the study. It is well known that the protein concentration of milk from mothers delivering preterm is initially higher than that from mothers delivering at term [The results of this study indicate that protein intake was greater in VLBW infants when MOM was supplemented with preterm rather than term donor milk. These infants fulfilled during the donor milk period the minimum protein requirements according to both ESPGHAN guidelines (3 g/kg/day) [The above results demonstrate that feeding VLBW infants with PDM, when MOM is not sufficient, and starting fortification when the quantity of enteral feeds reaches 50–100 mL/kg/day, protein intake surpasses the amount of 3.5 g/kg/day as ESPGHAN (2022) recommends [Overall, there are great discrepancies in literature regarding the effect of early nutrition on anthropometric parameters of VLBW infants, especially when pasteurized donor milk is used. It is important to note in previous studies whether the results were documented before or after the practice of human milk fortification was initiated. Historically, before the era of human milk fortification, studies showed that infants fed with MOM supplemented with pasteurized DM exhibited growth retardation based on anthropometric measurements of body weight, length and head circumference over a period of time [In 2014, Dritsakou et al. [The novelty in the design of this study was the comparison of PDM with TDM. To our knowledge, this is the first study that investigates the potential benefits of preterm donor milk on protein intake and growth in preterm infants. Only Fang et al. [Another strength of this study was the use of breast milk analyzer (Miris HMA) which allowed for the direct measurement of the exact protein concentration in MOM, PDM and TDM. In most studies, milk protein content is estimated using median calculated values in term donor milk [Limitations of this study were associated with the difficulty in recruiting mothers delivering preterm. As a result, preterm donor milk was in limited supply and thus the donor milk period was restricted to the first three weeks of life. The limited source of preterm donor milk has also impacted the number of infants enrolled in the study.