1. BREAST MILK FORTIFIER For Premature Babies

2. supplement for human milk for feeding preterms and LBW infants
(especially in those of very low birth weight < 1500 g).
Soluble powder * easy to add to breast milk
( 4 scoop=4.3g BMF in 100ml BM )
Supplies energy (carbohydrate), hydrolysed protein, minerals
(especially Ca/P), vitamins and trace elements
15 kcal per 4.3 g (4 scoop )- ESPGHAN recommendations
Designed to meet preterm nutritional guidelines and provide
same nutrient composition as LBWF

3. Levels of key nutrients in breast milk fortifier & fortified breast milk

4. Introduction Premature infants have special nutrient needs;
They have small endogenous nutrient reserves,
Immature physiological systems,
An unstable medical condition,
Increased growth rate(Intra-uterine growth rate which should be emulated by preterm infants is about three times higher than that of term infants.

5. Human Milk Fortification
Preterm infants fed exclusively on human milk : - Grow more slowly and retain less nitrogen than those receiving a special low birth weight formula. -Abnormalities of bone and mineral metabolism are frequently reported ( Clinical rickets and fractures) Human milk has to be supplemented at least with protein, calcium and phosphorus. Furthermore, preterm human milk may be too low in vitamins (such as vitamin A, vitamin D, vitamin K, vitamin C and folic acid) to meet the requirements of the rapidly growing preterm infant.

6. Energy BMF+BM=15+70=85kcal/100ml
. A total energy intake of 120 kcal/ kg/ day is recommended in growing low birth weight infants, to allow for a weight gain of 18 to 20 g/ kg/ day
The volume of milk intake needed to meet the infants' energy requirement may be a problem, because of small gastric capacity or fluid intolerance
Preterm human milk ( kcal/100 ml )
HMF has 15 kcal per 4.3 g.
By addition of FMS to human milk, the recommended energy intake of 120 kcal/ kg/ day is met with a milk intake of about 150 ml/kg.

7. NO FAT
Fat supplementation has been observed not to influence growth in preterm infants fed human milk.
Fat in Breast Milk : 4 mg/100ml

8. Ca =BMF(65)+BM(22)=87mg/100ml P =BMF(45)+BM(14)=59mg/100ml
About 80 % of calcium and phosphorus are accrued by the foetus in the third trimester of gestation.
However, preterm breast milk provide insufficient P and to a lesser extent Ca for rapidly growing VLBW infant ,result in (disturbances in serum biochemical values, and deficits in bone mineralization ,clinical rickets and fractures .
Higher supplementation of human milk with phosphorus and calcium will have a negative effect on fat absorption.

9. No Iron
The infants' iron stores are sufficient for the first eight weeks of life.
Provision of dietary iron to these infants may therefore result in iron overload.
Fe in Breast Milk: 0.09 mg/100ml