Nutrient content of preterm human milk with various commercial fortifiers

	Preterm human milk (without fortifier)^*[1]	Nutrients per 100 mL of fortified preterm human milk
	Preterm human milk (without fortifier)^*[1]	Enfamil powdered HMF (bovine) 4 packets^[2]	Enfamil liquid HMF standard protein (bovine) 4 vials, 20 mL^[3]	Enfamil liquid HMF high protein (bovine) 4 vials, 20 mL^[4]	Similac concentrated liquid HMF (bovine) 4 pouches, 20 mL^[5]	Similac concentrated liquid hydrolyzed protein HMF (bovine) 4 pouches, 20 mL^[6]	Prolacta +4 donor human milk-derived HMF 20 mL^[7]	Prolacta +6 donor human milk-derived HMF 30 mL^[7]
Approximate kcal/oz, as prepared with preterm human milk^*	21 to 23	25.5 to 27.5	25 to 27	25 to 27	24.5 to 26.5	24.5 to 26.5	25.5 to 27.5	28 to 29.5
Energy (kcal/100 mL)	70 to 77	84 to 91	83 to 89	83 to 89	82 to 88	82 to 88	85 to 90	92 to 97
Protein (g/100 mL)	1 to 1.4	2.1 to 2.5	2.2 to 2.6	2.7 to 3	2 to 2.3	2.5 to 2.8	2 to 2.3	2.5 to 2.8
Fat (g/100 mL)	2.6 to 3.7	3.6 to 4.7	4.1 to 5	4.1 to 5	3.1 to 4	2.9 to 3.8	4 to 4.9	4.6 to 5.4
Sodium (mg/100 mL [mEq/100 mL])	16 (0.7)^[8]	32 (1.4)	36 (1.6)	36 (1.6)	30 (1.3)	30 (1.3)	49 (2.1)	51 (2.2)
Calcium (mg/100 mL)	25 to 29	117	120	120	140	122	116	122
Phosphorus (mg/100 mL)	12 to 14	63	63	63	77	67	64	66
Iron (mg/100 mL)	0.1	1.5	1.6	1.6	0.5	0.5	0.1	0.1
	Recommended targets (per kg/day)^[9]	Total daily nutrients with full feeds (160 mL/kg/day) of fortified preterm human milk
	Recommended targets (per kg/day)^[9]	Enfamil powdered HMF (bovine) 4 packets^[2]	Enfamil liquid HMF standard protein (bovine) 4 vials, 20 mL^[3]	Enfamil liquid HMF high protein (bovine) 4 vials, 20 mL^[4]	Similac concentrated liquid HMF (bovine) 4 pouches, 20 mL^[5]	Similac concentrated liquid hydrolyzed protein HMF (bovine) 4 pouches, 20 mL^[6]	Prolacta +4 donor human milk-derived HMF 20 mL^[7]	Prolacta +6 donor human milk-derived HMF 30 mL^[7]
Energy (kcal/kg/day)	110 to 130	134 to 146	133 to 143	133 to 143	131 to 140	131 to 140	136 to 145	147 to 155
Protein (g/kg/day)	3.5 to 4.5	3.4 to 4	3.6 to 4.1	4.3 to 4.9	3.2 to 3.7	4 to 4.5	3.2 to 3.7	4 to 4.4
Fat (g/kg/day)	4.8 to 6.6	5.8 to 7.5	6.6 to 8	6.6 to 8	4.9 to 6.4	4.6 to 6.1	6.4 to 7.8	7.4 to 8.6
Sodium (mg/kg/day [mEq/kg/day])^¶	69 to 115 (3 to 5)	51 (2.2)	58 (2.5)	58 (2.5)	48 (2.1)	48 (2.1)	78 (3.4)	81 (3.5)
Calcium (mg/kg/day)	150 to 220^[10]	187	190	190	222	196	186	195
Phosphorus (mg/kg/day)	75 to 140^[10]	100	101	101	124	108	102	105
Iron (mg/kg/day)	2 to 3	2.5	2.5	2.5	0.7	0.7	0.1	0.1

Values in the table above are calculated from fortified human milk prepared according to the manufacturer's directions. For the liquid Similac and Enfamil products, 20 mL of fortifier is added to 100 mL of human milk. For the Prolacta +4 product, 20 mL of fortifier is added to 80 mL of human milk. For the Prolacta +6 product, 30 mL of fortifier is added to 70 mL of human milk.

HMF: human milk fortifier.

* Values for macronutrient and mineral content of human milk are based on average content of mature preterm milk (ie, milk produced by a mother 5 to 12 weeks after preterm birth)^[1]. The actual macronutrient content of human milk varies substantially between individuals and over the course of lactation.

¶ To convert sodium mg to mEq, divide by atomic weight of 23 or use this calculator.

References:

Gidrewicz DA, Fenton TR. A systematic review and meta-analysis of the nutrient content of preterm and term breast milk. BMC Pediatr 2014; 14:216.
Mead Johnson Nutrition. Enfamil® Human Milk Fortifier Powder. Available at: https://www.hcp.meadjohnson.com/s/product/a4R4J000000PpQiUAK/enfamil-human-milk-fortifier-powder (Accessed on August 17, 2021).
Mead Johnson Nutrition. Enfamil® Human Milk Fortifier Acidified liquid. Available at: https://www.hcp.meadjohnson.com/s/product/a4R4J000000PpR7UAK/enfamil-human-milk-fortifier-acidified-liquid (Accessed August 17, 2021).
Mead Johnson Nutrition. Enfamil® Liquid Human Milk Fortifier High Protein. Available at: https://hcp.meadjohnson.com/s/product/a4R4J000000PpQRUA0/enfamil-liquid-human-milk-fortifier-high-protein (Accessed on September 12, 2023).
Abbott. Similac® human milk fortifier concentrated liquid. Available at: https://abbottnutrition.com/similac-human-milk-fortifier-concentrated-liquid (Accessed on November 22, 2020).
Abbott. Similac® human milk fortifier hydrolyzed protein concentrated liquid. Available at: https://abbottnutrition.com/similac-human-milk-fortifier-hydrolyzed-protein-concentrated-liquid (Accessed on November 22, 2020).
Prolacta Bioscience. Preterm Nutrition Products. Available at https://www.prolacta.com/en/products/preterm-nutrition-products/ (Accessed on September 12, 2023).
Pietrzak-Fiećko R, Kamelska-Sadowska AM. The Comparison of Nutritional Value of Human Milk with Other Mammals' Milk. Nutrients 2020; 12:1404.
Current recommendations of advisable nutrient intakes for fully enterally fed preterm VLBW infants. In: Pediatric Nutrition, 8th ed, Kleinman RE, Greer FR (Eds), American Academy of Pediatrics 2019.
Abrams SA, Committee on Nutrition. Calcium and vitamin D requirements of enterally fed preterm infants. Pediatrics 2013; 131:e1676.

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Nutrient content of preterm human milk with various commercial fortifiers