Postnatal attainment of intrauterine macromineral accretion rates in low birth weight infants fed fortified human milk

Hypothesis: Provision of more bioavailable mineral sources as human milk supplements enables very low birth weight (VLBW) infants to meet the intrauterine accretion rate for calcium and phosphorus. Design: Comparison of currently formulated human milk fortifier with previous formulation. Setting: Neonatal level II and III nurseries Patients: Twenty-six healthy, VLBW infants, whose mothers chose to breast-teed. Interventions: We tested the effects of two formulations designed for VLBW infants as human milk supplements and differing primarily in their quantity and source of Ca, P, and magnesium. The study interval began with a milk intake of 100 ml kg-1 day-1 and ended when a body weight reached 2.0 kg. Main outcome measures: Net absorption and retention of Cab, Pa, and Ma during a nutritional balance study conducted once during the study interval, growth during the entire study interval, and bone mineral content of the radius were measured at the beginning and end of the study interval. Results: The newer Ca gluconote-glycerophosphate preparation (given to group CaGP) resulted in greater net absorption and retention of Ca and P (p 0.01) than in infants given Ca phosphate (group CaTB). Mg retention was greater than (in group CaGP) or equivalent to (in group CaTB) the intrauterine accretion rate. Radius bone mineral content was significantly greater in group CaGP than in group CaTB (p < 0.001). Volumes of the fortified human milk preparation needed to meet the needs for gain in body weight were higher in group CaGP than in group CaTB (p < 0.001). Conclusions: Intrauterine accretion rates for Ca and P can be achieved when VLBW infants are fed human milk supplemented with Ca gluconote-glycerophosphate. Supplementation of human milk with Ma may not be indicated. In this study, greater intakes of Ca and P, and not improvements in bioavailability, result in improved net retention and bone mineral content of VLBW infants.