Approximately 7% (estimated 1300 in 2004) of babies in Western Australia are born prematurely (before 37 weeks) and KEMH is the only tertiary care maternity hospital in Western Australia with the facilities to care for mothers with high-risk pregnancies
Currently, babies survive and develop into normal children when born as early as 23 weeks of gestation from high-risk pregnancies.
Breast milk provides the basis for an optimum food for pre-term babies because it has a desirable nutrient balance and contains many nucleotides, hormones and growth factors, which are not in infant formula. Although the gastrointestinal tract (GIT) of the pre-term baby is under developed it is important that the pre-term baby receives food not only to nourish its growth but also because it’s GIT requires an intake of food for its functional development.
Infection is a frequent and serious complication of pre-term birth and results in increased suffering and cost as well as significant long-term illness. Babies fed breastmilk have much less infection than those fed formula largely due to many unique anti-infective properties of human milk. Hospitals that have a strong emphasis on providing mother’s own milk for pre-term babies have a much lower rate of very serious diseases of the GIT such as necrotizing enterocolitis (NEC) which is one of the commonest causes of mortality after pre-term birth. About 5-10% of these babies develop NEC in the USA with 30% mortality.
Breast milk feeding results in a better outcome for the pre-term baby and enormous savings in the cost of the treatment of these babies because sick pre-term babies spend a much longer time in the Neonatal Intensive Care Unit (NICU). In the USA if a pre-term baby develops NEC but does not require surgery the additional cost of care is USD $73,700 and if the baby requires surgery the additional cost is USD $186,200. In Chicago a hospital with a very high usage of human milk for pre-term babies has a NEC rate of only 3%. This hospital actually does fortify human milk with human milk fat with very positive results. Our initial proposal is to fortify human milk with both human milk fat and human milk protein.
While breast milk is the only food required for the first 6 months of life for a term baby to grow and develop normally, it does not contain a sufficient nutrient density to enable the pre-term baby to achieve the same rate of growth as would be expected during late pregnancy. Indeed, the energy, protein, sodium, calcium, phosphorus and magnesium content of breast milk are not high enough to meet the optimal rate of growth required for pre-term infants. Currently this problem is overcome by fortifying the mother’s breast milk.
That is, a special mixture is compounded from cow’s milk and added to the mother’s breast milk so that the nutrient content of her breast milk is increased. Although this type of fortification improves the growth of pre-term babies, it is not ideal because the composition of the protein, fat and growth promoting factors in cow’s milk differs significantly from breast milk and the growth and development of pre-term infants is still below that of term infants.
Most mothers (70%) of pre-term babies express more that 350ml/24h of breast milk once their lactations are established. A pre-term baby only requires about 150-200ml breast milk per day. Thus most mothers produce a surplus of breast milk and we plan to replace the modified cow’s milk fortifier with a fortifier produced from the excess breast milk produced by the baby’s mother (a mother’s own milk fortifier).
This is achieved by first removing the milk fat and adding it in a concentrated form to the mother’s own milk to increase the energy content of the milk. The protein is then concentrated approximately 5 fold in the remaining fat free milk and this concentrated protein is also added to the mother’s own milk. By careful measurement of the composition of the breast milk it is possible to provide the pre-term baby with human milk of a precisely known composition taking into account any variations in the composition of the individual mother’s milk (it should be noted that currently variations in the composition of the individual mother’s milk is not taken into account when breast milk is fortified with formula).
Although this is the most complicated part of the total milk bank project, it is the logical starting point as the processing of mother’s own milk does not require the stringent health screening that is required for donor milk.
Nevertheless, the special equipment required for processing of mother’s own milk also would have the capacity to process donor milk. Other Milk Banks around the world primarily provide unprocessed human milk for babies whose mothers are unable to provide enough breastmilk for their developmental needs.
The concept of processing breastmilk to meet the specific needs of at risk babies has not been done elsewhere and therefore there is intense International interest in this project. Confirmation of this International interest is verified by the recent visit of Professor Jane Morton, Director of Breastfeeding Medicine,
Stanford University,
USA
