MetroHealth research seeks best way to enrich breast milk

30 May 2011

No food is more nutritious for babies, especially preterm newborns, than breast milk. Except, perhaps, fortified breast milk. But researchers at MetroHealth Medical Center have discovered that the nutritional content of a woman's breast milk can change. Measuring the variations, and determining how best to enrich the breast milk, is the challenge.

It is well known that breast-milk-fed babies have lower rates of infection and stronger immune systems than babies who are primarily fed formula. Some studies also have shown lower rates of obesity and diabetes later in life.

An American Academy of Pediatrics' policy statement even calls for hospitals and physicians to "recommend human milk for premature and other high-risk infants, either by direct breast-feeding and/or using the mother's own expressed [pumped] milk."

The assumption has always been that a woman's breast milk has the exact amount of nutrients that her baby needs. But for babies born prematurely, that isn't the case.

"Human milk is the best thing we can feed preterm babies," said Sharon Groh-Wargo, a neonatal nutritionist at MetroHealth and an associate professor of pediatrics and nutrition at Case Western Reserve University School of Medicine. But preemies, who often lose weight after they're born before beginning to gain, have higher nutritional requirements than babies born at full term, she said.

"One of the key nutrients we're really worried about is protein," Groh-Wargo said. "What we're seeing in preemies is that when they gain weight, they're often gaining more fat, not muscle."

In the neonatal inventive-care unit, or NICU, it is common practice to fortify a woman's breast milk with a commercial human milk fortifier to increase protein, calories and mineral content. Most fortifiers used in the NICU are powder or liquid supplements made from cow's milk.

But the problem is that hospitals don't account for the wide variability in a woman's breast milk, Groh-Wargo said. "Some moms have milk higher or lower in protein and fat, [but] we fortify mothers' milk in the same way."

To address that issue, a handful of research groups across the country and in Canada are working to create technology to custom-fortify a woman's breast milk so that her baby can thrive.

Last summer, a team of local researchers led by Groh-Wargo began studying breast-milk samples from 28 women whose babies were in MetroHealth's NICU.

They found that a woman's milk varies in nutritional content over time.

Those preliminary findings were presented this month at the annual meeting of the Pediatrics Academic Societies. Groh-Wargo said she hopes to begin a multicenter, randomized control trial sometime in 2012 to validate the findings.

With help from two Cleveland companies -- Metron Instruments and Paragon Data Systems --Groh-Wargo launched the study last summer to get a handle on the variability of breast milk.

"We wanted to get at, can we analyze it? How often would we have to do it?" she said.

Metron, headed by David Anderson, is one of only four companies in the world that makes breast-milk analyzer instruments.

Part of the expertise Metron has brought to the project is its Calais Milk Analyzer, a secondary measurement to more costly and time-consuming chemistry. The analyzer provides test results that show the amount of fat, protein, lactose and calories in samples of expressed breast milk.

Paragon, led by Larry Laurenzi, specializes in helping other companies accurately manage their inventories, including hospitals' breast-milk inventories.

A couple of years ago, Laurenzi, a John Carroll University graduate, teamed up with NeoMed Inc., an Atlanta-area company run by a college classmate, to create the SafeBaby Breast Milk Tracking System. The system, which manages the storage, identification and feeding of expressed breast milk for premature and critically ill babies, is used at UH's Rainbow Babies & Children's Hospital and two other hospitals in the country, Laurenzi said.

Paragon then set out to explore how to put nutritional information on identification labels.

In June, six months after mutual acquaintances got Groh-Wargo, Anderson and Laurenzi together for the first time in Cleveland, they started working on the study.

"Analyzing breast milk and getting nutritional value is only half of the story," Laurenzi said. "The other half is customizing a fortification plan."

The group completed data collection earlier this year. Using the study findings, Paragon is developing a software program called SafeNutrition, which will help health care professionals in NICUs create a customized breast-milk-fortification program for premature babies.

A handful of research groups across the country and in Canada are working to create technology to custom-fortify a woman's breast milk so that her baby can thrive.

The hope is to eventually have a tool available that would indicate how often to test a mother's milk, whether it's once a week or once a month, Groh-Wargo said. "[We would know to include] more or less protein or calories to make sure we knew what we were giving the baby."

A team of researchers at the University of California San Diego Medical Center is also conducting a study to examine the chemistry of breast milk, how to best handle and preserve the milk, and how to provide the support women need to produce milk while their babies are in the NICU.

The university's near-infrared analyzer can use a smaller quantity of human milk to get measurements, said Dr. Jae Kim, a neonatologist and gastroenterologist.

"Nutrition has become one of the most important areas in neonatal medicine because [premature babies] are surviving," said Kim. The field has become much more aware of the importance of providing preemies with breast milk.

"Now we're focused on the very refined details of what they eat," he said.

Source: MetroHealth Medical Center