Table 1 Individualized Human Milk Fortification Methods [7]
HM Fortification Method | Characteristics | Advantages/Disadvantages |
|---|---|---|
1. Adjustable (ADJ) HM Fortification | BUN is monitorized twice weekly, cut-off levels of BUN are 10–16 mg/dl. If the level is less than 10 mg/dl extra protein is added to the standard fortification. | Practical, not labor intensive Monitors protein status of each infant Safeguards also against excessive protein intake Does not need expensive devices Proven to be effective in optimizing growth and protein intake with a RCT. A real individualization method taking into consideration each infant’s protein requirement |
2. Targeted HM Fortification | Macronutrient concentrations in HM are analyzed and based on the results milk is supplemented with extra protein and/or fat. | Both protein and energy can be supplemented Bedside analyzers are available but are expensive May be labor intensive More importantly the method supplements the milk according to the general recommendations, does not take into consideration that each individual infant’s requirement may be different |