Breast feeding /

Human milk fortifier for preterm infants

01 In Brief

Breast milk is the ideal feeding for all infants. The composition of human milk is sufficient for term infants, however it is insufficient for the needs of the growing preterm infant under 2000gm. Fortification of breast milk with HMF helps supports rapid growth and bone health in the preterm infant.

02 What Do I Need To Know?

The protein content of human milk must be increased to meet the requirements of a preterm infant. The estimated protein requirement for a preterm infant is 3.0 to 4.0 g/kg per day compared to 1.5 to 2.0 g/kg per day for the term infant. The requirement for the preterm infant does not include additional allowances for catch-up growth that are due to losses of lean body weight prior to the infant surpassing birthweight. If these allowances are included, the recommended protein content increases to 3.4 to 4.2 g/kg per day.

Milk supplied by the preterm infant's mother is the preferred enteral feeding. Although milk produced by a mother who delivers prematurely may have increased protein content compared to term milk, the protein content declines in the first weeks of lactation to that of term milk. Human milk fortifier supplies additional protein, which has been shown to increase concentrations of blood urea nitrogen and weight gain in the enterally feeding preterm infant.

Human milk fortifier does not augment the immunologic properties of human milk. Human milk contains secretory immunoglobulin A as well as other factors such as lactoferrin and lysozyme that confer immunologic protection upon the infant. The carbohydrate content of preterm human milk may be slightly lower than term human milk, but it is well tolerated in spite of the intestinal lactase functioning at 30% of the level of a term infant. The iron content of human milk is lower than that of iron-fortified formula, but nearly 50% is absorbed. Human milk fortifier does not significantly increase the carbohydrate content or enhance the absorption of iron. Of note, the addition of human milk fortifier does increase the osmolality of enteral human milk feedings.

03 Clinicians Tools and Resources

  • University of Iowa Children's Hospital

Guidelines for the use of Human Milk fortifier in Neonatal intensive care unit


The information published here has been reviewed by Flourish Paediatrics and represents the available published literature at the time of review.
The information is not intended to take the place of medical advice.
Please seek advice from a qualified healthcare professional.
Read our terms and conditions

Last updated: 25/12/2013