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Children’s Hospital Colorado pilots new tool to customize breastmilk for the smallest babies

Children’s Hospital Colorado is looking at expanding its program to analyze and customize breastmilk after trying it with the smallest babies.

Breastmilk is particularly important for premature and low-birthweight babies because they’re at a higher risk of a potentially fatal condition called necrotizing enterocolitis, in which the intestines become inflamed and tissue can die. Formula-feeding increases that risk in more fragile babies.

While unfortified breastmilk generally meets the average baby’s needs, those who are born early or unusually small need extra nutrients to catch up on the growing they didn’t get to do before birth. Typically, hospital neonatal intensive care units have fortified every mother’s milk by the same amount, though some in other states started customizing earlier, said Mary Ann D’Ambrosio, a lactation consultant in the Aurora hospital’s NICU.

Essentially, they test the milk to find out how much fat, protein and carbohydrate it contains, then make up the difference with a fortifier made from cow’s milk that’s been processed so the babies’ bodies won’t have an allergic reaction to it, said Susan Marshall, a clinical dietitian in Children’s neonatal intensive care unit.

They start with what a typical baby needs based on the number of weeks since the pregnancy started, then consider individual medical conditions and how well the infant is growing so far, she said.

“We often call it the art to the science,” she said.

D’Ambrosio said they’ve initially tried custom fortifying for babies who were born weighing less than 1,500 grams (about 3.3 pounds) and whose growth stalled out a month post-birth. Eventually, they could expand it to a wider group of babies, she said.

“This program’s pretty much in its infancy,” she said.

When babies have the right balance of nutrients, they’re more likely to have healthy muscle growth and see their head circumference expand as expected, said Kirsten Halstead, clinical manager of lactation support services for the Children’s NICU. They also have a lower risk of lung and eye complications.

A 2016 review of the research on fortifying breast milk for premature infants found some evidence that babies fed fortified milk grew slightly faster while hospitalized, though there wasn’t enough data to say much about any effects beyond infancy. The studies included in the review used different protocols, however, so it’s possible that the included babies didn’t receive the optimal level of supplementation.

The composition of breast milk varies over time and even within the same day, but it’s not feasible to test it after each pumping session, D’Ambrosio said. Typically, they examine all of the milk a mother pumped over 24 hours once or twice a week, to get an idea of the average nutritional content, she said.

The technology also allows them to process the breastmilk to remove components that certain babies can’t absorb because of medical conditions, and replace those with versions of the nutrients that will work better for that individual, Halstead said. They’ll likely be able to do for more babies in the coming years, she said.

Testing the milk can help the caregivers figure out faster if something else is wrong, such as a vitamin deficiency or a medical condition, Marshall said. Generally, the default response if a baby wasn’t growing well would be to give them more calories, which might put them on an unhealthy growth trajectory if they add too much fat without growing longer and building muscle, she said.

“We’re setting this baby up for life,” she said.

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