Fat supplementation of human milk for promoting growth in preterm infants

Human breast milk provides good nutrition for term infants for growth and has benefits for immunity and maternal-infant bonding. It may, however, contain insufficient quantities of some nutrients and calories to meet the needs for adequate growth of an infant born prematurely unless fed in large volumes. Fats provide approximately half of the calories in human milk and the milk contains components (bile-salt stimulated lipase) that help digest the fat. The fat component in some commercial human milk fortifiers is often in very low quantities because of concerns that preterm infants will deposit fat tissue to a greater extent than when in the uterus. They also have relatively poor digestion and absorption of fat with their immature digestive systems. Supplementing with medium-chain triglycerides (MCT), which are more easily digested than long-chain fats, may provide a ready source of energy for preterm infants for growth and neuronal development. The review authors searched the medical literature and found only one small randomised controlled trial (14 infants) investigating the effectiveness of human milk fat supplements with vitamins and minerals (calcium and phosphate). Growth was similar with and without fat supplement over the short study period. One infant in the fat supplement group developed feeding intolerance and there were no reports of damaging inflammation of the gut (necrotizing
enterocolitis).