Feeding the World's Smallest, Most Fragile Babies

Pioneering advances in preterm nutrition are helping NICU babies become their strongest selves.

Newborn baby feet in a blue blanket

By: Bridget Barrett-Reis, Ph.D., RDN, a researcher with Abbott who specializes in neonatal nutrition science.

Nourishing Fragile Babies

Globally, more than 1 in 10 pregnancies, or about 15 million babies annually, will end in a premature birth according to the World Health Organization. And without the right care and nutrition these babies can be at risk of mortality and long-term health challenges.

In the NICU, you'll quickly find out that feeding premature babies is extremely challenging. Tiny babies have teeny, tiny stomachs, and in one feeding, a premature infant might not be able to ingest more than a tablespoon of liquid. Also, many of them are fighting health challenges that often limit their ability to feed.

We turn to breast milk first because it's incredibly beneficial, but it needs a nutritional boost to get premature babies where they need to be in terms of growth and development. That's where human milk fortifiers come in. These nutritional fortifiers are added to breast milk and provide additional essential nutrients like protein, vitamins and minerals. They've been used for more than a decade, but until just a few years ago they were only available in powder forms.

Related Infographic: What is a Human Milk Fortifier (HMF)?

To address safety concerns around mixing fortifier powders and to deliver the additional protein that low-birth-weight preemies need, we knew we needed to develop a nutrient-dense, commercially-sterile liquid human milk fortifier, but this undertaking was not without unique obstacles.

Finding a way to fit dense nutrients into such minuscule servings took our team years of study and development. To further complicate matters, some of these nutrients, when added to breast milk, can actually interfere with the milk's naturally-occurring nutrients. For instance, some mineral sources can bind to components of mother's milk causing nutrient absorption issues which can impact a baby's growth. Also, we needed to ensure the fortifier was easy to digest.

Scientist Bridget Barrett-Reis works in the laboratory on the latest human milk fortifier.

Life-saving Advances

Overcoming these challenges has been well worth it. In 2013, we launched the first of our concentrated liquid human milk fortifiers and more recently, we introduced Similac® Human Milk Fortifier Hydrolyzed Protein. This fortifier is the only one that has extensively hydrolyzed, or broken-down, protein which is easy for premature babies to digest and absorb. It also has lutein and DHA to help support brain and eye development. This fortifier can be mixed into breast milk without interfering with the nutrients that are already present, ensuring that premature babies get the increased nutrition they need to grow.

An Abbott-supported study published in the Journal of Pediatric Gastroenterology and Nutrition shows that this fortifier helps support optimal growth as well as tolerance, or ease of digestion, in preterm infants. And babies that are thriving — gaining weight and growing daily — may get to leave the hospital sooner.

Tailored Feedings Support Individual Needs

My experience in hospitals, including neonatal and pediatric intensive care units, gave me an appreciation for how hard healthcare teams work to feed babies. In the NICU, individualized feeding based on a baby's changing needs is the standard of care. To make the task easier for dietitians, Abbott developed a nutrition software system called WebNova Neonutrition Optimizer.

Here's how it works: Say you have half the volume of breast milk you need for a feeding and you need to add a fortifier. You can simply input the volumes of human milk, fortifier and preterm formula into the system and it will crunch the numbers for you — ensuring that you are always providing optimal, nutritionally-balanced feedings. Not only that, if a baby has special nutritional needs you can target specific nutrients, seeing if you can boost some and minimize others. NICU dietitians can create and improve the quality of each feeding with this nutritional calculator.

Bringing Baby Home

Our research doesn't stop at hospital care. Preterm babies are often smaller than their term-born counterparts when they reach 40 weeks gestation. This is about the time preterm infants are discharged from the hospital to home. We know that babies born early benefit immensely from optimized nutrition once they leave the hospital so we've developed products for parents to use at home.

For babies going home, we provide human milk fortifiers for breastfed infants and other formulas like Similac NeoSure® which supports important catch-up growth during a baby's first year. NeoSure, an extensively studied post-discharge formula, has more protein, calcium, phosphorus, and other nutrients than formula designed for full-term infants. Compared to preterm babies fed standard infant formula, preemies fed Similac NeoSure have demonstrated improved catch-up growth1. Also on NeoSure, they have shown increased lean body mass growth2 and improved visual and language development3.

Working Toward the Future

We're always thinking about ways to further improve the health and lives of these babies. Working with emerging science is exciting, and in the years ahead we plan to make great strides in both aiding brain and digestive development in preemies. Preterm nutrition is miles ahead of where it was when I started at Abbott, and we will continue to improve our ability to care for premature infants.

An important motivating factor for me — and my colleagues — is that we're passionate about helping theses vulnerable babies grow and thrive so they can they go home for the first time. It's a rewarding privilege to help develop these innovative nutritional products that help preemies become their strongest selves.


[1] Carver JD, et al. Pediatrics 2001;107:638-689.

[2] Groh-Wargo S, et al. Pediatr Res 2005;57:712.718.

[3] O'Connor DL, et al. Pediatrics 2001;108:359-371.

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