Could Lacto-engineering replace Human Milk Fortifiers in the future?

Breast is Best.

This is the phrase that has been resonating for many decades since the fall of the popularity of breastfeeding. With the rise of technological advancements and research, men are now "proving" and validating what creation attests to and what women have always known - any other method of infant feeding is suboptimal.

In the ideal situation, an infant would receive nutrition solely from his mother's breasts, because nothing more or less, is necessary. There are situations, however, that do require intervention and careful consideration to special circumstances of each individual infant where mother's milk is concerned. A few such instances are rare conditions such as phenylketonuria, galactosemia (with exception to duarte's variation.), and in some cases of LBW ( low birth weight ) and VLBW* infants.

There is no question of the value of human milk for a sick baby. With its immunological properties that ward off countless infections, there should be no doubt that a preterm infant who needs more of these, should receive it's mother's milk. Human milk has the ideal protein balance for babies who weigh 1500g or more. On the other hand, concern has risen over whether the total volume of protein and minerals such as calcium and phosphorous found in human milk is sufficient for preterm infants. At issue are the calcium and phosphorous requirements for the VLBW baby's bone growth. Without enough of these minerals, VLBW babies are at risk for osteopenia of prematurity. VLBW babies also require a higher amount of fat-soluble vitamins because they have not laid down adequate stores before birth. One solution is to supplement the baby with Human Milk Fortifiers (HMF.)

Many breastfeeding advocates propose lactoengineering for preterm infants. The science of lactoengineering, the engineering of human milk, holds much promise. Lactoengineering provides increased calories, carbohydrates, and proteins through the mother's hindmilk. Creamatocrits estimate the fat and energy content of milk. (1) The hindmilk that rises to the top is skimmed off and given to the baby to increase his fat intake. Mothers can learn to do this, thereby increasing their participation in their babies' care (2). Low birth weight infants in Nigeria grew well through lactoengineering (3) One researcher added isolated human milk protein to mother's milk for four babies with good results. (4)

Some argue that the focus with human milk fortifiers is often on weight gain rather than brain growth.(5) However, this focus ignores the fact that human milk  is clearly the nutrition of choice to promote neurodevelopment. Researchers can also separate the proteins and calcium in human milk.(6) (7). The goal is to develop human milk fortifiers for infants that are made from human milk, not from the milk of other species.

 The field of lactoengineering is a field with many opportunities that has yet to be explored, with unequivocally good results. Hopefully in the future we will see more advancements that propagate breastfeeding and raise it back to the pedestal it once occupied.


* Low Birth Weight (LBW) : Under 5 lb, 8 oz (2500g)
   (March of Dimes 2003)

*Very Low Birth Weight (VLBW) : Under 3 lb , 5oz (1500g)
   (March of Dimes 2003)

*Extremely Low Birth Weight (ELBW) : Under 2 lb, 3 oz
  (Siva Subramanian, 2002)


Notes:


 (1) Meier P. Supporting lactation in women with very low birth weight infants. Pediatr Ann 32 (5): 317-325; 2003.


(2) Griffin T et al. Mothers' performing creamatocrit measures in the NICU: Accuracy, reactions, and cost. JOGNN 29 (3): 249-257; 2000


(3) Slusher T et al. Promoting the exclusive feeding of own mother;s milk through the use of hindmilk and increased maternal milk volume for hospitalized, low birth weight infants. (<1800g) in Nigeria: A feasibility study. J. Hum Lact 19 (2): 191-198; 2003


(4) Lindblad BS et al. Blood levels of critical amino acids in very low birth weight infants on a high human milk protein intake. Acta Paediatr Scand Suppl 296: 24-27; 1982

(5)Ebrahim G. Feeding the preterm brain. J Trop Pediatr 39:1430-1431: 1993


(6) Li C. Variations in the composition of breast milk and its fortification for Pre-term babies. Amarillo Conference, Human Lactation: Current research and clinical implications, breastmilk for Pre-term babies; October 22,2004


(7) Kent J. Breastmilk calcium for the preterm baby. Amarillo Conference, Human Lactation: Current research and clinical implications, breastmilk for Pre-term babies; October 22,2004