Happily expecting their second child, Valencia and Jude Koomson were surprised when a prenatal visit revealed that Valencia had dangerous pre-eclampsia (high blood pressure that can occur during pregnancy). The diagnosis, just 28 weeks into her pregnancy, led to immediate hospitalization and, within days, premature birth of their son.
That was the best option for the health of both Valencia and her baby. But baby Justin, born 12 weeks before his due date and weighing just over 3 pounds, would require intensive support to continue to grow and develop outside the womb.
At Brigham and Women’s Hospital, mother and baby benefited from the deep expertise, cutting-edge technology and human touch of the largest newborn intensive care unit (NICU) in New England. With breathing assistance for Justin’s developing lungs and a feeding tube to deliver human breast milk to his belly, he grew and thrived. He graduated from the intensive support area of this Level III NICU to the Growth and Development area, no longer needed oxygen support and became strong enough to feed on his own.
One novel technology available to him was a breast milk analyzer, a countertop device that assesses nutritional composition of human breast milk. Justin was among the first babies enrolled in a new research study in the Brigham Department of Newborn Medicine to examine whether knowing the exact nutrition contained in individual feedings of human milk, and adding just the right fortification, could aid the smallest of babies.
A milk analyzer measures the composition of human breast milk.
Pre-term Babies Have Special Nutritional Needs
“We know that more optimal nutrition is a predictor of better growth and neurodevelopment,” says Mandy Brown Belfort, MD, MPH, a neonatologist and researcher in the Brigham Department of Newborn Medicine. “We are investigating whether routine milk analysis and individualized fortification will help us reduce accumulated nutrient deficits, achieve better short-term growth and ultimately improve long-term outcomes for our small patients.”
Human breast milk is uniquely equipped to meet nutritional needs of full-term babies. But pre-term babies – especially those born before 35-36 weeks’ gestation – generally require that a fortifier containing calories, protein, calcium and micronutrients such as zinc and Vitamin A be added to a breast milk diet. This is to approximate the robust nutrition the baby would receive from the mother’s placenta if still in the womb.
Typically, a preemie’s growth is followed very carefully, but the fortifier is only adjusted if the baby’s weight gain slows down over several days. Dr. Belfort is using the milk analyzer to avoid the time lag and deliver accurate, customized fortification with each feeding.
The milk analyzer initially was developed and used in the dairy industry. Recently adapted for human breast milk, it is approved for use in Europe and Canada. In the United States, it is currently available only for research purposes. The Brigham is one of very few NICUs engaged in that research.
Can Just the Right Fortification Help Newborn’s Growth?
Prior research by Dr. Belfort and others has shown surprising variations in the nutritional composition of a mother’s milk during the course of a day. Nutritional makeup also varies from one mother to the next, not necessarily related to the mother’s diet. It’s also known that nutritional quality degrades somewhat as expressed milk is handled and stored.
Because nutrition is so essential for a baby born early, and because many of these babies receive a combination of donor milk and maternal milk, Dr. Belfort turned to the milk analyzer.
In her current study, each feeding of milk is sampled and analyzed using the counter-top device that sits in the NICU’s milk storage room. A tiny syringe, containing less than a teaspoon of milk, is inserted into the analyzer. A readout shows within seconds the milk’s nutritional elements. The results determine how much fortifier should be added on top of the standard fortifier to ensure that nutrient targets are met.
Study results won’t be known immediately as to whether this nutritional fine-tuning will improve growth and development in pre-term babies. The first patients began in the study in spring 2018. Belfort’s team is continuing to offer NICU families the opportunity to volunteer.
“A Baby Needs to Eat to Grow”
Whether or not a baby is in the study, the Brigham NICU’s expertise on feeding and lactation assistance eases the sometimes-arduous process of expressing milk – especially for NICU mothers recovering from the early birth. A pre-term baby who is not yet mature enough for feedings at the breast still can benefit from a mother’s milk.
Valencia Koomson, a scientist herself, was glad to know that she was giving her baby every opportunity to grow, while contributing to newborn science.
“We are thrilled and blessed that he could participate to customize his feedings to his specific nutritional needs,” Koomson said, looking forward to Justin’s expected discharge from the NICU to home. “It was great to know he was getting the exactly proper composition of calcium and protein.”
“Particularly for NICU mothers, there is so much anxiety and uncertainty about what your baby needs,” she said. “It’s a great comfort to know he’s being fed well here. A baby needs to eat to grow.”
– Sandra J.