Are You Prioritizing Human Milk-Based Fortifier in Your NICU?

Updated: Jul 20

While human milk has many nutritive components to support a healthy gut, fend off disease, and benefit the immune system, it may lack the calories preterm infants need for adequate nutrient intake. Low birth weight (LBW), very low birth weight (VLBW) and extremely low birth weight (ELBW) infants have incredibly demanding growth needs. Initially, premature infants fed only human milk had poorer growth outcomes and other issues resulting from malnutrition when compared to their formula-fed counterparts. Fortifier was created to supplement nutrition needs and to avoid postnatal growth failure.

The advent of adding fortifier to human milk feeds in neonatal intensive care (NICU) has no doubt saved a great many infants. It enabled clinicians to feed nutrient-rich human milk supported by a calorie-dense fortifier to their most at-risk patients, which promoted physical growth. But there was a catch. Early fortifier options were derived from cow’s milk.

There was no doubt that cow’s milk-based formula and cow’s milk-derived fortifiers made a tremendous impact to infant growth. Yet, cow’s milk fortifier could not provide the maternal immune components (including antibodies, cytokines, growth factors, and oligosaccharides) from human milk fortifier could offer to protect these vulnerable infants against infectious diseases. Nutrition research at the time had not yet proven the vast short- and long-term positive health impacts of human milk. And yet preterm and immunocompromised infants needed all of the above.

A need for human milk-based fortifier

Today we have a deeper understanding of the benefits of human milk feeding in the NICU. Extensive research has demonstrated superior contributions to infant development and outcomes when compared to cow’s milk formulas. The American Academy of Pediatrics recognizes and recommends an exclusive human milk diet for infants based on its incidence reduction of necrotizing enterocolitis (NEC), sepsis, and mortality, especially for VLBW and ELBW infants.

While a majority of clinicians supported an exclusive human milk diet for these reasons, they also knew early fortifier consisted of cow’s milk. Studies have shown even a relatively small amount of cow’s milk protein still correlates with development of NEC (1) even when combined with human milk feeding. An increase in adverse outcomes has been observed with the use of cow’s milk-derived fortifier, even when combined with mother’s own milk (2).

Was the potential for increased incidence of NEC, sepsis, retinopathy of prematurity (ROP) and mortality a risk worth the tradeoff for cow’s milk caloric growth opportunities?

For many years there was no choice. Now there is.

New human milk fortifier choices for the NICU

The donor human milk industry understood the need for a human milk-based fortifier. As champions of human milk feeding who knew the research, they also knew a human milk-based fortifier could benefit infants by eliminating the risk of cow’s milk proteins and replacing them with the powerful benefits of breast milk. Companies like Medolac invested efforts into developing such fortifiers to support exclusive human milk feeding.

Human milk-based fortifiers are now more widely available than ever before, which supports healthcare efforts to provide an exclusive human milk diet to at-risk infants. Emerging science continues to demonstrate the advantages of combining human milk-based fortification with mother’s own milk or donor milk for improved neonatal outcomes. The days of a lack of understanding human milk benefits are over. And that means better outcomes are ahead.

The Medolac Benefit nutrition portfolio is the only human milk-based nutrition that meets recommendations for commercially sterile replacement feeding in the NICU. Learn more about this shelf stable donor milk resource and the NEW human milk-based fortifier, FortifyMVP.


1. Sullivan S, et al (2010). An exclusively human milk-based diet is associated with a lower rate of necrotizing enterocolitis than a diet of human milk and bovine milk-based products. J Pediatr. 2010 Apr;156(4):562-7.e1. doi: 10.1016/j.jpeds.2009.10.040.

2. Lucas, A, et al (2020). Preterm infants fed cow’s milk-derived fortifier had adverse outcomes despite a base diet of only mother’s own milk. 2020 Breastfeeding Medicine Vol. 15, No. 5.