Composition of Breast Milk from Mothers of Preterm Infants

Steven J. Gross, Jane Geller and R. M. Tomarelli

Pediatrics 1981;68;490-493

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http://www.pediatrics.org

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Composition
of Breast
Preterm Infants
Steven

J. Gross,

MD,

From the Department

Carolina,
and Wyeth

ABSTRACT.
sion

The

milk

of breast

amined

by

who

comparing

delivered

mothers

influence
of daily mechanical
on nutritional
composition
expressed

preterm

delivering

cally

expressed

their

infants

at

milk

term:

all milk
at the

milk

with

nine

and

breast.

12

two

mothers

five

mothers

groups

who

mothers

Collections

mechani-

who

were

of

obtained

groups
and

mothers

of

infants

at the breast
was mechanically

The

cantly

dium,

concentrations

of protein,

sodium,

and

chlo-

ride, and lower concentrations

of lactose
than the milk
from either
group
of mothers
delivering
at term.
The
mean
concentrations
of protein,
sodium,
chloride,
and
potassium
in early preterm
milk were adequate
to meet
the estimated
requirements
for the preterm
infant.
However, there was large variability
in nutritional
composition
of milk among
mothers
and among
samples
from the
same mother.
Pediatrics
68:490-493,
1981; human
milk,
milk

composition,

infant

nutrition.

second

from

several

position
suit
In

intake

supply

studies

centration
milk from

have

demonstrated

of protein,2
sodium,2
and
mothers
delivering
preterm

in milk from mothers

for these
differences

may be important.
delivering
prematurely

expressed

milk,

all

nursed
occasional

analysis.

uous
was
mothers

whereas

their
infants
day when

delivering

Reprint

490

at

at the breast
except
milk
was
expressed

for
for

present
study,
the effect
of continmechanical
expression
on milk
composition
studied
by comparing
expressed
milk
from
In

the

delivering

prematurely

with

Jan 9, 1981; accepted

(S.J.G.)
P0 Box 3967,
Medical
Center,
Durham,
NC 27710
PEDIATRICS
(ISSN
0031 4005). Copyright
American
Academy
of Pediatrics.
Received

The reason
methods
of

In previous
studmechanically

mothers

for publication

requests

to

PEDIATRICS

Vol.

68

No.

milk

from

two

Feb 3, 1981.
Duke
University
1981

4 October

Marked

from

to examine

individual

milk.

early
for

in

milk

protein,
of

so-

the

pre-

however,
preterm

were
milk
in com-

differences

mothers

could

re-

or excesses
of some
nutrients.
diurnal
variations
in milk
com-

also result
in inappropriate
a fraction
of the mothers
to feed her infant.

might
if only
is used

Pre-

preterm

energy

values

when

nutrient
daily
milk

and Methods

con-

chloride2
in
infants
than

delivering
at term.
is unknown,
but

milk expression
ies, mothers
term
the

a greater

was

calculations,

mothers.

of

a week

of breast
that

nutrient

of milk

Materials
Recent

These

mothers

day

study

requirements
and

in inadequacies
addition,
large

position

of this

potassium,

mean

on

term:

North

expressed
all milk
who
nursed
their

except
one
expressed.

estimated

infant.3

Durham,

at

suggested

chloride,

based

Center,

mechanically
healthy
infants

have

meet

term

PhD

in composition

data

may

R. M. Tomarelli,

purpose

variability

vious

of

delivering

who

the

higher

of mothers
infants

intervaLs
over a period
of 24 hours
so that
variability
of constituents
in milk of different
mothers,
as
well as variability
in the same mother
over a 24-hour
period,
could be assessed.
Preterm
milk contained
signifi-

Mothers

Medical

sick

at

four-hour

and

Duke University
Philadelphia

milk

nursed

MS,

Geller,

of Pediatrics,
Laboratories,

expreswas ex-

from

from

Jane

Milk from

by

Milk Donors
Milk
period

collections
from
three

were
obtained
during
a 24-hour
groups
of mothers.
Group
1 in-

cluded

12 mothers

who

32 weeks

gestation

chanically
mothers

expressed
who gave

gestation

(mean

mothers

were

therefore,

Group
weeks

and

weeks).
unable

Complete
breasts
were

Infants
to nurse

born

to these

at the

breast;

mechanically
expressed
all milk.
five mothers
who gave birth
at 40
to healthy
infants
who were nursed

at the breast
at all times
except
days when
milk was expressed

Collection
the

39.5

mothers

birth
between
27 and
30 weeks).
Mothers
me-

all milk. Group

2 included
nine
birth
between
38 and 40 weeks

sick

3 included
gestation

gave

(mean

for the intermittent

for analysis.

of Milk
24-hour
obtained

milk
collections
from
at four-hour
intervals

1981

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both
(2 AM,

6 AM, 10 AM, 2 PM, 6 PM, 10 PM)

4, 7, 14, 21, and 28 for mothers
and on postpartum
in group
3 (nursing
7).

To

ensure

vious

day

days
was

that

was

completely

no

7, 14, 21,

not

at 10 PM prior

prior

milk

the

mothers
to day

Fat. There
were
no differences
in mean
fat concentrations
in milk from the three
groups
of mothers (Figure).
Stage
of lactation
and
milk
volume
produced
no significant
effects
on fat concentration.
Lactose.

from

the

were

emptied

cantly

24-hour

milk

breasts

to beginning

four-hour
measured,

days
1 and 2

28 for

and

interrupted

residual

included,

collection.
Each
lected
separately,

on postpartum
in groups

each

milk expression
and stored

pre-

was
at -20

colC.

Concentrations

lower

or T nursed

(Figure).

In milk

lactose

Methods

Protein
concentration
from
Kjeldhal
nitrogen4

was

estimated
6.38.
Fat

in duplicate
content
was

determined
in duplicate
according
to the RoeseGottlieb
mixed
ethers
extraction
method4
on sampies acidified
prior
to ether
extraction
to ensure
the
extraction
mined

ing

of free
by

an

lactose

fatty

automated

standards

Tarrytown,

acids.

NY).

Lactose

colorimetric

deter-

procedure

(Technicon
Defatted

was

us-

Instrument

milk

samples

Co,

were

ana-

iyzed
for sodium,
potassium
and chloride-sodium,
and potassium
by atomic
emission
spectrophotometry and chloride
by a colorimetric
automated
procedure
(Technicon).
Caloric
concentration
was calculated
as the sum of protein
x 4.27, lactose
X 3.87,
and

fat

x 8.87

Statistical

and

Analyses

weighed

milk

analysis

sample

by volume

concentrations.
concentrations

values

to obtain

Comparisons
among
groups
of covariance,

were

24-hour

of 24-hour
were performed

controlling

was

because

first

for

no cyclic

Between

Concentrations
month
oflactation

with
with

Protein

(Figure).

progressing
milk
volume

covariance

lactation
in all

demonstrated

concentration
< 0.05) when
milk volume

groups

increased

with

milk

and

that the
remained

Electrolytes.
chloride

milks

between
Analysis

progressing

similar

of mothers,
progressing

milk,

there

lactose
concenof covariance

decreased
lactose
concentrasignificant
(P < .05) when

of lactation

T expressed
and chloride

were

T expressed

and

The
concentrations
significantly
higher

were

in either
Sodium

milk

or T nursed
concentrations

lactation

and

volume

of sodium
in PT milk

and
than

milk
(Figure).
decreased
with

varied

indirectly

milk
volume
in all three
groups.
sodium
and chloride
concentrations
nificant
when
the effects
of day
milk volume
were
controlled.

nutrient
using

changes
volume.

postpartum

trend

within

Preterm

and Term

were

and
three

with

The
increased
remained
sigof lactation
and

Milks

that

the

in PT milk
remained
the effects
of stage
were controlled.

increased
significant
of lactation

with

stage

three

groups

of mothers

Variability

in Milk

Content.

volume

and

in milk

volumes
period

was

observed

among

was

greatest

in milk
The

stage

postpartum

day
ranged

of lactation

of milk
were
not

the
No

or milk

produced
different

during
in the

(Figure).

Considerable

nutrient

individual
from

variability

lactational
lections

is

mothers.
mothers

of

ifiustrated

Variability
delivering

milk

at

any

for

14. Milk volume

from
32 to 915

van-

concentrations
pre-

particular

PT

milk

from

from 24-hour
colml. Caloric
values

ranged
from
50 to 75 kcal/100
ml primarily
due to
the wide spread
in fat concentrations
(2.6 to 4.5 gm/
100 ml). Protein
concentration
ranged
from
1.50 to
3.84 gm/100
ml.
Similarly,
sodium
and
chloride

milk)
term
milk
their
were

indirectly
Analysis

of milk
produced
by
were
similar
(Figure).

Mean
lactational

maturely.

concentrations
than
50 mEq/liter.

decreased

varied
groups.

noted

Volume.

of protein
throughout
were significantly
higher

concentration

values
of mothers

groups

each

a day

in milk from
mothers
delivering
preterm
(PT
than
in either
milk from mothers
delivering
at
who expressed
all milk
(T expressed
milk)
or
from
mothers
delivering
at term
who nursed
infants
(T nursed
milk).
The two term
milks
similar

all three

the effects
of stage
were controlled.

ability

Comparisons

The

PT

milk

T expressed

from

relationship
milk
volume.

demonstrated
tion in PT

three

RESULTS

the

was a direct
tration
and

nutrient

observed.7

Protein.

For

term

signifi-

were

in either

milk.

demonstrated.
Energy.
Caloric

pooled

day and milk volume.

Diurnal
variation
was compared
using
the coefficient
of variance
as a measure
of magnitude,

than

Concentrations
of potassium
in milk
from
the
three
groups
of mothers
were
similar
(Figure).
No
effects
of stage
of lactation
or milk
volume
were

kcal/gm.6

six 4-hour

The

of lactose

milk

concentration

lactation.

Analytic

in PT

were
of

protein

the
milk

(P
and

found
end

varied

in PT
of the

contained

the

estimated

For
180

mi/kg/day,

example,

from

less

Variations

milk

first

at each

month

concentrations
requirements
milk
from
provided

than

10 to

of similar

post

lactational
partum,

stage.

By

some

PT

of nutrients
for the

preterm

one mother,
her preterm

below
infant.8

when

ARTICLES

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greater

magnitude

infant

fed at
with

491

only
105 kcal/kg/day,
2.1
gram
per day, and 1.3 mEq
per day. These
calculations

gm of protein
of sodium
per
were
derived

hour
nutrient
values
and do not reflect
within
the 24-hour
period.
Diurnal
variation
occurred
randomly
tematic
magnitude

cyclic
changes
of diurnal

during
variation

lactational
stage;
therefore,
stages
were
combined
for

per kilokilogram
from
24-

shows
coefficients
vation
from the
concentrations

variations
with

of variation
(mean
percent
deridaily mean)
for volume
and nutrient
for milk
from
the three
groups
of

mothers.
groups.

There
were
no
The
largest
diurnal

for milk

volume

no sys-

a 24-hour
period.
The
was similar
at each

results
of all lactational
each
group.
The
Table

(18%

differences
variations

to 27%)

and

among
the
were
found

concentrations

of

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Day Postpartum

delivering
term
who

Nutritional
prematurely
expressed

492

COMPOSITION

Figure.

composition
of milk
(circles),
mothers
all milk (triangles),

OF

BREAST

delivering
at term who
Values represent
means

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(squares).

TABLE.

Variation

Diurnal

Protein

Fat
Lactose
Sodium
Chloride
Potassium

are

used

coefficients

from

daily

of

T Nursed
Milk

6.5
19.0

6.0
18.0

6.8
15.4

4.6
17.9

4.1
14.6

11.5
9.4

10.3
8.1

10.7
6.9

9.3

8.8

8.4

26.7

Volume

Abbreviations

are:

25.3

PT,

T, term.

(mean

percent

is read

from

related
The

linearly
inability

(10%

to 19%),

sodium

(15%

Values

deviations

to 18%),

and

chloride

DISCUSSION
during

the

first

month

tein,

sodium,

and

oflactose
at

than

term.

when

chloride,

milk

These
the

of

were

controlled.

paring

preterm

and

chanical

been

mothers
at the

expression

assessed

milk

nutritional

composition

have

milk,

delivering
breast.
milk

been

was

composition

Our

milk

their
infants.
variability

to

similar

from

and
individ-

stage
of lactation,29
and diurnal
varia-

be

compositional

ever,
a large
variability
individual
mothers,

milk

individual
and
volume,

the

most

important

differences.

Each

be

assumed

of

study
at
how-

composition
for
PT
in protein,

from
milk.

volume.
mothers

without
method
of human

The
milk

knowledge
for estimating
milk, based

in
inde-

nutritional
adequacy
for her infant
cannot
of its

with

increased

the

wide

range

of nutrient

adequate

nutrient

concenas well
makes

as
in-

of expressed

concentrations

for

thank

R. Weaber
for his help in data
Muhlbaier
for statistical
advice.

John

Lawrence

composition.

the fat and energy

on the centrifugation

1. Atkinson
SA, Bryan MH, Anderson
GH: Human
milk: Differences
in nitrogen
concentration
in milk from mothers
of
term and preterm
infants.
J Pediatr
93:67, 1978
2. Gross SJ, David Ri, Bauman
L, et al: Nutritional
composition of milk produced
by mothers
delivering
preterm.
J
Pediatr
96:641, 1980
3. Atkinson
SA, Radde
IC, Chance
GW, et al: Macro-mineral
content
ofmilk
obtained
during early lactation
from mothers
of premature
infants.
Early Hum Dev 4:5, 1980
4. Official
Methods
ofAnalysis
of the Association
of Official
Analytical
Chemists,
ed 11. Washington
DC, Association
of
Official Analytical
Chemists,
1979
5. Deleted
in proof
6. Composition
of Foods.
Agriculture
Handbook
No. 8-1.
United
States
Department
of Agriculture,
1977
7. Arrnitage
P: Statistical
Methods
in Medical
Research.
Oxford, Blackwell
Scientific
Publications,
Ltd, 1977
8. Ziegler
EE, Biga RL, Fomon
SJ: Nutritional
requirements
of the premature
infant, in Suskind
RM (ed): Symposium
of
Pediatric
Nutrition.
New York, Raven
Press, 1981
9. Ldnnerdal
B, Forsum
E, Hambraeus
L: A longitudinal
study
of the protein,
nitrogen,
and lactose contents
of human
milk
from Swedish
well-nourished
mothers.
Am J Clin Nutr 29:
1127, 1976
10. Forsum
E, Ldnnerdal
B: Variation
in the contents
of nutrients of breast
milk during one feeding.
Nut
Rep
mt 19:815,
11.

lactose,

chloride
were related
to differences
fat and energy
content
varied

pendent
of milk
of an individual
A simple
content

in milk
particularly
differences

as
ex-

delivering

in volume

milks

among

shown

of

by mothers

these
variables
was controlled
in the present
by obtaining
complete
24-hour
milk expressions
specific
lactational
stages.
There
still existed,

sodium,

not
that

indicate

produced

fed

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on

significant

and

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milk

infant.

authors

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term

contain
preterm

The

and

previous

produced

who breast-fed
is considerable

influences

term

day

to that

Whereas

However,

analysis

lactation

of

were pooled
of diurnal

composition.

breast

delivering

expression
was not responsible
differences,
inasmuch
at term
who
mechanically

at term
There

tion2

In

on

every

composition

ual women.
stage
of the

of

previously.

the method
of milk
for
the
compositional
mothers
delivering
pressed

remained

stage

is

ACKNOWLEDGMENTS

concentrations

by mothers

differences

effects

from
nursed

lower

produced

volume
tamed
were

and

conpro-

of

in

and

content.34
adequacy

milk

the

following

parturition
by mothers
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prematurely
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significantly
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nutritional

variation

milk

produced

to the fat
to predict

tube

trations
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from
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diurnal
variations
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valid
the assumption
that
all feedings

to 12%).

Milk

capillary

de-

frequency
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Previous
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as well as the present
data,
suggests
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the mean
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of protein,
sodium,
chloride,
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and
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may
be adequate
to
meet
estimated
requirements
for the preterm
in-

means).

(18%

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unless
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expressions
by the random
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fant.8
fat

the

centrifuge,
of cream
or

human
milk
was increased
Expressed

17.5

preterm;

variation

of milk
in an hematocrit
vised.
The
percentage

Composition*

T Expressed
Milk

7.2
19.3

Calories
4

in Milk

PT Milk

Nutrient

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66:626, 1980

ARTICLES

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493

Composition of Breast Milk from Mothers of Preterm Infants

Steven J. Gross, Jane Geller and R. M. Tomarelli
Pediatrics 1981;68;490-493
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