Original article Comparison of osmolality of human milk after fortification with three different fortifiers Poonam Singh a , Anup Thakur a , Shivani Dogra a , Pankaj Garg a , L.M. Srivastav b , Neelam Kler a, * a Department of Neonatology, Institute of Child Health, Sir Ganga Ram Hospital, Rajinder Nagar, New Delhi 110060, India b Department of Biochemistry, Sir Ganga Ram Hospital, Rajinder Nagar, New Delhi 110060, India A R T I C L E I N F O Article history: Received 13 December 2016 Accepted 15 February 2017 Available online 27 May 2017 Keywords: Osmolality Fortification HM (human milk) A B S T R A C T Objective: Fortification of human milk (HM) is a recommended method to improve its nutrient content but it increases osmotic load on immature gut. The present study was carried out to compare the osmolality of HM fortified with three different fortifiers after 4 h of fortification. Methods: In this prospective observational study, expressed HM collected from mothers of very low birth weight infants (birth weight <1500 g) between 7 and 14 days of delivery fortified with three different fortifiers were tested. Osmolality of unfortified HM after 24 h of collection (n = 15) and HM fortified with three different fortifiers Lactodex-HMF, HIJAM and FM-85 (n = 15 each) after 4 h of fortification was measured by the Genotec Osmomat 030 (Wheecon Instruments). Results: A total of 60 samples were analyzed. The mean gestation (SD) and birth weight (SD) of the infants were 30.43(2.3) weeks and 1241(243) g respectively. The mean osmolality (SD) of unfortified human milk and milk fortified with Lactodex-HMF, HIJAM and FM-85 were 293.53(12.39), 378.40(34.4), 419.73 (30.65) and 451.20(39.18) mOsm/kg respectively (p < 0.001). There was no difference in episodes of feeding intolerance or necrotizing enterocolitis (NEC) amongst the three fortifier groups. Conclusion: Fortification of human milk increases its osmolality. © 2017 Published by Elsevier, a division of RELX India, Pvt. Ltd on behalf of Sir Ganga Ram Hospital. 1. Introduction Human milk (HM) is the most beneficial source of nutrition for preterm infants because of its immune-nutritive properties which provide protection against sepsis, necrotizing enterocolitis (NEC), leads to shorter duration of hospital stay and better psychomotor development. 1 It is the recommended exclusive source of nutrition for first six months of life in full term infants. 2 Though HM provides several short term and long term benefits but feeding very low birth weight infants (VLBW) with HM alone cannot meet their higher protein, calorie and mineral requirements. 3,4 Exclusive feeding of unfortified HM has been associated with poor growth and nutritional deficits during and beyond the period of hospitalization. 5 A systematic review of ten randomized controlled trials has shown that multi-component fortification of HM in low birth weight babies weighing less than 1850 g resulted in small but statistically significant short term improvements in weight gain, linear growth and head size as compared to unfortified group. 6 Therefore fortification of HM is a standard practice. 7 Fortification improves postnatal growth and cognition by providing additional calories, proteins and other micronutrients but has potential to enhance osmolality of HM. 8–11 It is recommended that osmolality of enteral feeds should be kept below 450 mOsm/kg (which approximates to an osmolarity of 400 mOsm/L). 12 Most neonatologist across India use Lactodex-HMF for fortifi- cation of HM. 13 Recently two higher protein containing fortifiers HIJAM and FM-85 are available in the Indian market. These fortifiers differ in composition and may have differential osmolali- ty when added to HM. It is important to know the effect of these fortifiers on osmolality of HM as a higher osmolar load than recommended may potentially increase the risk of NEC. 14 The present study was designed to assess the impact of three different multi-component fortifiers; Lactodex-HMF, HIJAM and FM-85 on osmolality of human milk. * Corresponding author. E-mail addresses: drpoonamsingh@yahoo.co.in (P. Singh), dr.thakuranup@gmail.com (A. Thakur), Shivanidogra2003@yahoo.com (S. Dogra), pankajgarg69@gmail.com (P. Garg), lalitmohan67@hotmail.com (L.M. Srivastav), drneelamkler@gmail.com (N. Kler). http://dx.doi.org/10.1016/j.cmrp.2017.02.003 2352-0817/© 2017 Published by Elsevier, a division of RELX India, Pvt. Ltd on behalf of Sir Ganga Ram Hospital. Current Medicine Research and Practice 7 (2017) 81–83 Contents lists available at ScienceDirect Current Medicine Research and Practice journal homepage: www.else vie r.com/locate /cmrp