HOW APPROPRIATE ARE COMMERCIALLY AVAILABLE HUMAN-MILK FORTIFIERS

A preliminary investigation was made into the effectiveness of two bre astmilk fortifiers on the Australian market (FM-85 [Nestle, Vevey, Swi tzerland] and Enfamil Human Milk Fortifier [EHMF; Mead Johnson, Evansv ille, IN, USA]). Infants <1800 g and <34 weeks gestation at birth, who were receiving breast milk, were randomized to receive either of the fortifiers (n = 14 for FM-85, n = 10 for EHMF), until a weight of 2 kg was reached. Infants not receiving breast milk (n = 9) were fed a pre term formula (Prenan, Nestle). The two fortifier groups were similar i n most parameters examined: (i) weight gain (17.9+/-3.0 vs 17.4+/-3.5 g/kg per day); (ii) head circumference growth (1.02+/-0.28 vs 1.03+/-0 .25 cm/week); (iii) arm muscle area growth (32.6+/-20.0 vs 33.5+/-13.7 mm2/week); (iv) arm fat area growth (14.3+/-6.1 vs 14.0+/-8.7 mm2/wee k); (v) plasma calcium (2.52+/-0.08 vs 2.58+/-0.15 mmol/L); (vi) plasm a phosphate (2.02+/-0.21 vs 2.13+/-0.32 mmol/L); (vii) plasma copper ( 5.28+/-2.83 vs 5.66+/-3.07 mumol/L); and (vii) plasma zinc (13.3+/-5.5 vs 15.8+/-9.2 mumol/L). The FM-85 group had a higher alkaline phospha tase level (355+/-110 vs 231+/-70 iu/L) than the EHMF group; however, no values were outside the normal range. The Prenan group had a higher rate of weight gain (23.6+/-3.3 g/kg per day) and higher arm fat area growth rate (25.2+/-7.6 mm2/week) than the fortifier groups, while al l other parameters were similar. The incidence of feed intolerance was considered high in both fortifier groups. The addition of many of the components of breastmilk fortifiers has not been well validated and i t is proposed that a simplified fortifier composed of protein and phos phate may be better tolerated and equally effective at optimizing grow th and bone mineralization. The specific needs of extremely low birthw eight infants (< 1000 g) have not been addressed.