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Increased osmolality of breast milk with therapeutic additives

¹ Department of Paediatrics, Imperial College London, UK
² Department of Dietetics, Hammersmith Hospital, London, UK
³ Neonatal Intensive Care Unit Milk Bank, Queen Charlottes and Chelsea Hospital, Du Cane Road, London W12 0NN, UK

Correspondence to:
Correspondence to:
Professor Edwards
Department of Paediatrics, Imperial College London, Hammersmith Campus, Du Cane Road, London W12 0NN, UK; david.edwards{at}ic.ac.uk

Aim: To evaluate the changes in the osmolality of expressed breast milk (EBM) after the addition of seven additives and four proprietary fortifiers commonly used during neonatal intensive care.

Methods: The osmolality of 5 ml EBM was measured with increasing doses of 6% NaCl, caffeine, sodium ironedetate, folic acid, and multivitamin drops. Sodium acid phosphate and chloral hydrate were added to 8 ml EBM, and the fortifiers were added to standard volumes of EBM. Dose-effect curves were plotted, and the volume of milk that must be added to the above additives to maintain osmolality below 400 mOsm/kg was calculated.

Results: The osmolality of the pure additives ranged from 242 to 951 mOsm/kg. There was a significant increase in the osmolality of EBM with increasing doses of all additives except caffeine. The osmolality of EBM with many additives in clinically used dosages potentially exceeded 400 mOsm/kg. The greatest increase occurred with sodium ironedetate syrup, where the osmolality of EBM increased to 951.57 (25.36) mOsm/kg. Proprietary fortifiers increased the osmolality of EBM to a maximum of 395 mOsm/kg.

Conclusion: Routine additives can significantly increase the osmolality of EBM to levels that exceed current guidelines for premature infant feeding. A simple guide for clinical use is presented, which indicates the amount of milk required as diluent if hyperosmolality is to be avoided.

Keywords: expressed breast milk; osmolality; fortifiers; necrotising enterocolitis

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