Emerging Developments in Human Milk Fortification: Problem Solving for Clinical Practice

This education is about:

• Overcoming challenges to optimal preterm infant nutrition
• Strategic use of donor milk
•  Human milk fortification timing and clinical practice strategies
• Influence of feeding types on the preterm microbiome
• Emerging evidence on human milk bioactives
• Interprofessional collaboration in the NICU

Why it matters:

Human milk is the optimal feeding for preterm infants due to its nutritional and bioactive factors, supporting not only growth and development, but also the immune and gastrointestinal systems. However, questions remain regarding the optimal approach to human milk feeding in the NICU, including selection among fortification types, fortification timing, supplementation strategies, and the role of bioactives. Amidst these uncertainties, interprofessional collaboration and practical solutions to common preterm infant feeding challenges are urgently needed.

• Profile

  Michaela Berroya, MSN, RN, RNC-NIC

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  Michaela Berroya, MSN, RN, RNC-NIC, is a nurse clinician at New York-Presbyterian Hospital in New York City. She also serves as an adjunct pediatric clinical instructor at the New York University Rory Meyers College of Nursing, also in New York City. She received her master of science in nursing/nursing education degree from the University of Phoenix, Arizona.

  Ms. Berroya is a charge nurse in a 60-bed, level IV neonatal intensive care unit (NICU), one of the busiest and most highly regarded in the country. Her responsibilities involve overseeing the nursing care for critically ill infants and for educating and orienting new staff to the unit. She serves on the hospital’s Developmental Care Committee representing the needs of the NICU team, its patients and their families, and on several other committees.

  Recognizing the special concerns of parents whose infants spend time in the NICU, the hospital offers multidisciplinary developmental monitoring and nutritional support for the first three years of life—six years in the case of high-risk infants—through periodic follow-up milestone visits and evaluations.

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  Michaela Berroya, MSN, RN, RNC-NIC

  Nurse Clinician
  Neonatal Intensive Care Unit
  NewYork-Presbyterian Hospital
  New York, New York

• Profile

  Kirsten Frank, RD, CSPCC, LDN, CNSC, IBCLC

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  Kirsten Frank, RD, CSPCC, LDN, CNSC, IBCLC, is a neonatal dietitian at the Betty H. Cameron Women’s and Children’s Hospital of Novant Health New Hanover Regional Medical Center in Wilmington, North Carolina. She graduated magna cum laude from Syracuse University with a bachelor of science degree in coordinated dietetics. She received additional pediatric/neonatal education in high-risk infant nutrition at the Medical University of South Carolina and the Nestlé Nutrition Institute’s Advanced Nutrition Program.

  Ms. Frank is a registered dietitian and licensed dietitian/nutritionist. She holds board certification as a specialist in pediatric critical care; as an international lactation consultant; and as a nutrition support clinician.

  As a neonatal dietitian in the hospital’s 45-bed level III neonatal intensive care unit, Ms. Frank is a member of an interdisciplinary care team. She provides medical nutrition therapy, lactation support and manages the unit’s quality improvement nutrition initiative to enhance the use of feeding protocols and neonatal malnutrition diagnosis. She also assists with research studies and data collection, and is responsible for patient and medical student education.

  Ms. Frank is the primary author of a conference abstract titled “The Impact of a Newly Formulated Human Milk Fortifier on Growth Velocity and Tolerance in Preterm Very Low Birthweight Infants,” published in the July 2023 issue of Current Developments in Nutrition. The abstract describes a study to determine if a new non-acidified liquid human milk fortifier provides similar weight gain and growth patterns, as well as similar or better tolerance and morbidity, compared to an acidified liquid human milk fortifier. Data from the study suggest that the new fortifier is a suitable alternative.

  Ms. Frank is a member of several organizations including La Leche League International, American Society for Nutrition, Mead Johnson NICU Advisory Board, US Breastfeeding Committee, Academy of Nutrition and Dietetics, North Carolina Dietetic Association, and she is a frequently invited speaker at professional conferences throughout the United States.

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  Kirsten Frank, RD, CSPCC, LDN, CNSC, IBCLC

  Neonatal Dietitian
  Betty H. Cameron Women’s and Children’s Hospital
  Clinical Nutrition
  Novant Health New Hanover Regional Medical Center
  Wilmington, North Carolina

• Profile

  Ariel A. Salas, MD, MSPH

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  Ariel A. Salas, MD, MSPH, is associate professor of pediatrics and director of the Infant Nutrition Service Center in the Division of Neonatology at Children’s of Alabama, a pediatric acute care hospital affiliated with the University of Alabama at Birmingham (UAB). Dr. Salas received his medical degree from the Universidad Mayor de San Andrés in La Paz, Bolivia, completed residencies at Hospital del Niño Dr. Ovidio Aliaga Uría in Bolivia, and Children’s Hospital of Philadelphia, followed by a fellowship in neonatal-perinatal medicine at UAB, where he also earned his master’s degree in public health.

  Dr. Salas designed the Infant Nutrition Service Center at UAB to monitor body composition, nutritional practices and the growth of term and preterm infants before and after hospital discharge. Research and quality improvement projects from the Division of Neonatology and the Division of Maternal-Fetal Medicine are coordinated through the center and its multidisciplinary team of neonatologists, dietitians, speech pathologists, lactation consultants, neonatal fellows, and nurses, coordinates feeding practices across the hospital’s neonatal units. Prenatal counseling is provided for mothers whose babies are known to have complex medical conditions in order to provide them with valuable information and support prior to delivery.

  Dr. Salas’ research interests include enteral nutrition and feeding problems in preterm infants. The focus of his current work is the optimization of quantitative and qualitative outcomes of growth to reduce adverse neurodevelopmental outcomes in early childhood, after the early establishment of full enteral feeding in extremely preterm infants. His long-term research goal is to conduct multicenter randomized clinical trials, particularly in the understudied area of nutrition in very preterm infants.

  Dr. Salas is the author of numerous published manuscripts. He is an ad hoc reviewer for the American Society for Nutrition and Pediatric Academic Societies as well as for several prestigious medical journals including the American Journal of Obstetrics & Gynecology, Pediatrics, Journal of Pediatrics, JAMA Pediatrics, Journal of Perinatal Medicine, Journal of Parenteral and Enteral Nutrition, and European Journal of Pediatrics.

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  Ariel A. Salas, MD, MSPH

  Associate Professor
  UAB Department of Pediatrics
  Director, Neonatal Nutrition Program
  Director, Infant Nutrition Center
  Medical Director, Mother’s Milk Bank of Alabama
  Associate Medical Director, Continuing Care Nursery
  Division of Neonatology
  The University of Alabama
  Birmingham, Alabama

• Profile

  Brian K. Stansfield, MD

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  Brian K. Stansfield, MD, is vice chair for research and an associate professor in the Department of Pediatrics at Augusta University in Georgia. He completed his residency in pediatrics at Children’s Hospital of Georgia, followed by a fellowship in neonatal-perinatal medicine and a postdoctoral pediatric research fellowship at Indiana University.

  Dr. Stansfield’s research on early life growth is robust and includes factors affecting human milk composition, human milk fortification, and the effects of prematurity and other neonatal factors on adult diseases. Dr. Stansfield has published more than 100 journal articles, abstracts and book chapters on these and other topics related to neonatology, pediatrics, and biochemistry.

  At Augusta University, Dr. Stansfield’s academic responsibilities encompass curriculum development in neonatal physiology, research study design, and professional development. He serves as a section editor on the editorial board of Pediatric Research, as a reviewer for the Journal of Perinatology and Cellular and Molecular Life Sciences, and an ad hoc reviewer for numerous other medical journals.

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  Brian K. Stansfield, MD

  Associate Professor and Vice Chair of Research
  Department of Pediatrics
  Member, Vascular Biology Center
  Medical College of Georgia
  Augusta University
  Augusta, Georgia