HMF (human milk fortifier) should be recommended for neonates with birth weight below 1800 grams to improve weight gain, linear growth, and head growth. HMF provides important nutrients like protein, iron, vitamin D, and has an osmolality within safe limits. It should be added when the neonate starts accepting 100ml/kg of feeds, can be stored for 8 hours at 2-8°C, and continued until the baby achieves their birth percentile on growth charts or until 40 weeks. The use of HMF does not increase the risk of necrotizing enterocolitis and can be a cost-effective treatment compared to developed countries by decreasing hospital stay.

1. HIJAM-HMF
HUMAN MILK FORTIFIER
A READY RECKONER
1. When to recommend?
In neonates with birth weight below 1800 grams (ESPGHAN 2009 guideline)
Agostoni C, BuonocoreG, CarnielliVP, De-Cur s M.Enteral nutrient supply
forpreterminfants:commentary from the European Society for Paediatric Gastroenterology, Hepatology,
and Nutri on Commi ee on Nutri on. J Pediatr Gastroenterol Nutr 2010; 50:85–91
2. What are the benefits?
Improvements in weight gain (+2.33 g/kg/d; 95%CI 1.73, 2.93), linear growth (+0.12
cm/week; 95%CI 0.07, 0.18), and head growth (+0.12 cm/week; 95%CI 0.07, 0.16).
Kuschel CA, Harding JE. Mul component for fied human milk for promo ng growth in preterm infants
(Cochrane Review). Cochrane Library 2004; 3.
Be er test scores in the for fied group by 2.2 points for the Bailey Mental
Development Index, by 2.4 points for the Psychomotor Development Index, and by
3.1 points for social maturity at 18 months.
Lucas A, Fewtrell MS, Morley R, et al. Randomized outcome trial of human milk for fica on and development
outcome in preterm infants. Am J Clin Nutr 1996; 64: 142–51
3. At what age of the neonate HMF should be added?
HMF 1 sachet in 25 ml of expressed breast milk should be added when the neonate
starts accep ng 100ml/kg of feeds.
4. How long the recons tuted EBM + HMF can be stored?
It can be stored for 8 hours at 2-80C
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2. 5. When should HMF be stopped?
If the baby is on direct breast feeds at the me of discharge, HMF for fica on is
usually discon nued as it interferes with direct breast feeds.
If baby is on expressed breast milk, then HMF should be con nued ll baby
achieves its birth percen le on growth charts. Conven onally in such cases HMF is
con nued ll 40 weeks.
6. What is the most important advantages of Siroy’s HMF?
a) Siroy’s HMF provides 1gm protein per 100 ml of milk and protein intake has
shown to have impact not only on short term growth but also on long term
neurological outcome.
b) It provides high iron content 1.44mg (4 sachets)
c) Osmolality is with in safe limits.
d) Vitamin D content 400IU (4 sachets)
7. Does use of HMF increase the risk of Necro zing enterocoli s?
Systema c review comparing infants fed unfor fied and for fied HM did not show
any significantly increased risk of NEC in infants receiving For fied Human Milk (RR
1.33, 95% CI 0.7 to 2.5)
Kreissl A, Zwiauer V, Repa A, Binder C, Haninger N, Jilma B, Berger A, Haiden N. Effect of
fortifiers and additional protein on the osmolarity of human milk: is it still safe for the premature
infant? J PediatrGastroenterolNutr. 2013;57(4):432-7
8. Use of HMF makes the treatment costly or cost e ec ve?ff
Unlike the developed countries where the cost of HMF is prohibi ve, Siroy’s FM
comes with a reasonable cost and would help further cost cu ng by decreasing the
hospital stay.
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