Human-Based Human Milk Fortifier as Rescue Therapy in Very Low Birth Weight Infants Demonstrating Intolerance to Bovine-Based Human Milk Fortifier

Breastfeed Med. 2017 Nov;12(9):570-573. doi: 10.1089/bfm.2017.0017. Epub 2017 Aug 4.


Objective: To describe the results of utilizing a human milk-based human milk fortifier (HMHMF) as rescue therapy to meet nutritional requirements in very low birth weight and preterm infants demonstrating feeding intolerance to bovine-based human milk fortifier (BHMF) in the Canadian Neonatal Intensive Care Unit (NICU) setting.

Materials and methods: At two Level III NICUs in Winnipeg, MB, Canada, a rescue protocol was implemented to provide HMHMF for infants demonstrating intolerance to BHMF. To qualify for rescue, infants were required to experience two episodes of significant gastrointestinal (GI) symptoms associated with fortification with BHMF. A case series report was conducted retrospectively examining the success of rescue therapy, growth rates, protein, and calorie intakes before and after initiation of HMHMF in seven infants.

Results: Seven infants (birth weight 723 ± 247 g, gestation 25.3 ± 3.4 weeks) were treated with rescue fortification with HMHMF. All infants were transitioned off parenteral nutrition (PN) without relapse of GI symptoms. Growth rate, protein, and calorie intakes improved with the use of HMHMF.

Conclusions: Very low birth weight and preterm infants with GI intolerance to BHMF were successfully rescued with use of HMHMF. Improvements in growth were achieved without need for supplementation with PN through achievement of sufficient enteral calorie and protein intakes.

Keywords: feeding intolerance; fortifier; human milk; low birth weight; premature.

Publication types

  • Case Reports

MeSH terms

  • Animals
  • Canada
  • Cattle
  • Food, Fortified*
  • Humans
  • Infant Formula / adverse effects*
  • Infant Nutritional Physiological Phenomena
  • Infant, Newborn
  • Infant, Very Low Birth Weight / growth & development*
  • Infant, Very Low Birth Weight / immunology
  • Intensive Care Units, Neonatal
  • Male
  • Milk Hypersensitivity / diet therapy*
  • Milk Hypersensitivity / immunology
  • Milk Proteins / adverse effects*
  • Milk Proteins / immunology
  • Milk, Human* / immunology
  • Remission Induction
  • Retrospective Studies
  • Treatment Outcome


  • Milk Proteins