Fortifying the future: An innovative therapy for preterm infants

Dr Cyrus Contractor, Senior Consultant Pediatrician, Breach Candy Hospital, discusses advancements in pediatric care and the transformative benefits of human milk-based fortifiers for preterm infants

The birth of a preterm infant often comes with numerous health challenges, due to their underdeveloped organs and lower immunity. Preterm infants, born before 37 weeks of gestation, are at a higher risk for a range of health complications, including respiratory distress, gastrointestinal problems, and developmental delays. Their nutritional needs are also significantly higher than those of full-term infants yet, their delicate systems can struggle to process and absorb the nutrients they need. These tiny warriors, therefore, require specialised care to ensure they thrive and grow like their full-term peers. Since optimal nutrition is key to overcoming most of these challenges, 100 per cent human milk-based fortifiers (HMBFs) have emerged as a revolutionary tool in supporting the health of preterm infants. Evidence on HMBFs suggests faster catch-up growth, reduced incidence of mortality, and morbidity, and potentially shorter hospital stays.

Role of human milk

Breast milk is widely recognised as the best source of nutrition for infants, providing a perfect blend of nutrients, antibodies, and growth factors. For preterm infants, the benefits of breast milk are even more pronounced, as it aids in reducing the risk of necrotizing enterocolitis (NEC) and also supports overall growth and immune development. 

However, breast milk alone falls short of meeting the higher nutritional demands of preterm infants. This is where human milk fortifiers come into play.

Risk of complications with bovine fortifiers

Traditionally, bovine milk-based fortifiers (BMBF) have been used to supplement breast milk for preterm infants, but they come with significant risks. The immature digestive systems of preterm infants often struggle to digest bovine proteins efficiently, resulting in feeding intolerance and poor nutrient absorption. These fortifiers can also trigger allergic reactions and gastrointestinal complications, such as feeding intolerance, sepsis, and NEC. Such adverse outcomes may prolong hospital stays and escalate healthcare costs, putting an additional burden on families and healthcare systems. 

Thus, the use of bovine milk-based products in these vulnerable populations highlights the need for safer, more compatible alternatives that can meet their specialised nutritional needs without compromising their health.

Introduction of Human Milk-Based Fortifiers

Human milk-based fortifiers (HMBFs) are supplements derived 100 per cent from human milk, specifically formulated to enhance the nutritional profile of a mother’s breast milk, while retaining the bioactives that are unique to human milk alone. These fortifiers are designed to be seamlessly integrated with human milk, boosting essential nutrients such as calories, proteins, vitamins, and minerals, which are critical for the growth and development of preterm infants. Unlike traditional bovine-based fortifiers which are made from bovine milk with added synthetic ingredients, HMBFs closely mimic the composition of human milk. This bio-compatibility allows preterm infants to receive an exclusive human milk-based diet (EHMD), while preserving the natural immunological and developmental benefits inherent in breast milk, making HMBFs a more suitable and effective option for their delicate systems.

Benefits of human milk-based fortifiers

  • Better growth and development: HMBFs provide additional calories with better absorption of protein, vitamins, and minerals necessary for the rapid growth and development of preterm infants. Studies have shown that infants receiving HMBFs experience better growth outcomes compared to those receiving bovine-based fortifiers.

  • Reduced risk of NEC and mortality: HMBFs significantly reduce the risk of necrotizing enterocolitis NEC, a severe and often fatal gastrointestinal disease common among preterm infants. HMBFs are more compatible with the infant’s digestive system, reducing inflammation and promoting healthier gut development. This lowers the incidence of NEC and other gastrointestinal complications, which are major contributors to preterm infant mortality


  • Enhanced immunity and reduced incidence of sepsis: HMBFs improve the immune system of preterm infants with the immunological components present in human milk, including immunoglobulins, human milk oligosaccharides (HMO), and other bioactive molecules that help protect against infections and illnesses that preterm infants are particularly vulnerable to due to their underdeveloped immune systems. By providing enhanced immune protection, HMBFs decrease the likelihood of sepsis. 


  • Better digestive health: Human milk contains specific bioactive compounds that aid in gut maturation. These include enzymes, hormones, growth factors, lactoferrin, and HMOs that help in the development and functioning of the gastrointestinal tract. HMBFs retain these beneficial components, promoting gut health and reducing the likelihood of digestive problems.


Human milk-based fortifiers represent a significant advancement in the care of preterm infants by bridging the nutritional gap and harnessing the natural benefits of breast milk. The introduction of HMBFs has enhanced the standard of care for neonatal intensive care units (NICUs) worldwide. In the journey to ensure every preterm infant has the best start in life, HMBFs stand out as a novel nutritional strategy, delivering both the goodness of human milk nutrients and the gentleness of breast milk. Thus, HMBFs have become an important part of the nutritional arsenal, which forms the cornerstone for an Exclusive Human Milk diet in NICUs.

bovine milk-based fortifiers (BMBF)Breach Candy HospitalBreast milkDr Cyrus Contractorhuman milk-based fortifiers (HMBFs)preterm infants
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