The Advanced Strategies of Human and Donor Milk Fortification and its Effect on Long-term Outcome in Preterm Babies

Poor growth in intrauterine and extrauterine life and inadequate protein supplementation in babies during the first weeks of premature babies are linked to long-term growth failure and poor brain development. The calorie requirements of premature newborns cannot always be fulfilled, even with routine and traditional fortification. This is because traditional fortification procedures rely on the presumed well-known composition of human milk rather than the calculated one. The protein content of mothers' milk of preterm babies varies, decreases with breastfeeding duration, and differs with donor human milk being preserved in milk banks for a long duration. Newer fortification techniques are needed to solve these problems of protein and micronutrient undernutrition, which have led to the concept of "lacto-engineering." This review article focuses on feeding practices, traditional and targeted fortification, bedside human milk content analysis, lactoengineering, and its implications in the neonatal intensive care unit (NICU), particularly in developing countries.