Interet de la supplémentation du lait maternel "à la carte"

Despite the benefits of human milk fortification, nutrients of human milk are not sufficient to cover the greater needs of very low birth weight and to ensure a growth similar to that of premature infants fed with preterm formula. These differences could be related to the variation in the macronutrient composition of expressed breast milk with lower protein and energy content. Unfortunately there is unusually no information on macronutrients composition prior human milk fortification. With such data, it would be possible to individualize the fortification. In order to use adjustable fortification of human milk, we have assessed a rapid and simple method using full spectrum infrared laser technology (Milkoscan) to analyze human milk composition. We describe the variation in concentration of protein, lipid and energy in the human milk received in our neonatal unit. Then we evaluate the benefit of adjustable fortification of human milk compared with standard fortification. After standard fortification the variability of protein and lipid remains with a risk of protein deficiency or excess and a risk of energy deficiency. After adjustable human milk fortification based on human milk analysis using Milkoscan, we observe a more stable protein content and a lower amount of added fortifier decreasing the risk of hyperosmolarity. Furthermore, the energy content is higher following of the fat human milk adjusted content. Up to now, our preliminary results suggest that individualized fortification of human milk improves growth rate in preterm infants (21 g/kg/d) to a level close to formula fed infants.