{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T06:52:59Z","timestamp":1791355979824,"version":"4.3.1"},"reference-count":31,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2013,10,1]],"date-time":"2013-10-01T00:00:00Z","timestamp":1380585600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. pediatr. gastroenterol. nutr."],"published-print":{"date-parts":[[2013,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives:<\/jats:title>\n                    <jats:p>\n                      The present guidelines of the American Academy of Pediatrics recommend that osmolarity not exceed 450 mOsm\/kg (or approximately an osmolarity of 400 mOsm\/L) for breast milk or infant formulae, to minimize the risk factors for necrotizing enterocolitis. A commercial protein supplement has been developed to meet special protein requirements (4.0\u20134.5 g \u00b7 kg\n                      <jats:sup>\u22121<\/jats:sup>\n                      \u00b7 day\n                      <jats:sup>\u22121<\/jats:sup>\n                      ) of infants with a birth weight &lt;1000 g. Because its effect on osmolarity has not been systematically studied, we characterized the effects of fortification on the osmolarity of human milk (HM).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>Osmolarity of fresh and processed HM was measured at baseline, after fortification with a commercial HM fortifier and after further supplementation with additional protein increasing in 0.5\u2010g steps up to 4.0 g. Measurements were performed immediately after adding fortifier and\/or protein and after 24 hours. In addition, changes in osmolarity were determined after adding therapeutic additives such as iron, multivitamin supplement, and calcium\u2010phosphorus capsules.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      Native HM samples (n = 84) had 297 mOsm\/L, (median; 95% confidence interval 295\u2013299 mOsm\/L). Adding HM fortifier increased osmolarity up to 436 mOsm\/L (95% confidence interval 431\u2013441 mOsm\/L). Additional protein supplementation increased osmolarity by 23.5 mOsm\/L per 0.5\u2010g step, up to a maximum of 605 mOsm\/L. Pasteurization decreased osmolarity by 20\u201330 mOsm\/L (\n                      <jats:italic>P<\/jats:italic>\n                      &lt; 0.001), and storage for 24 hours slightly increased osmolarity (by 11.5 mOsm\/L\n                      <jats:italic>P<\/jats:italic>\n                      = 0.0002). Therapeutic additives increased osmolarity up to 868 mOsm\/L.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>Adding HM fortifier and additional protein to HM increased osmolarity to &gt;400 mOsm\/L and therefore above the recommended threshold. Because of the excessive increase in osmolarity combinations of HM + fortifier and additional protein should not be applied together with multivitamins or other additives.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1097\/mpg.0b013e3182a208c7","type":"journal-article","created":{"date-parts":[[2013,7,12]],"date-time":"2013-07-12T18:21:56Z","timestamp":1373653316000},"page":"432-437","source":"Crossref","is-referenced-by-count":65,"title":["Effect of Fortifiers and Additional Protein on the Osmolarity of Human Milk"],"prefix":"10.1002","volume":"57","author":[{"given":"Alexandra","family":"Kreissl","sequence":"first","affiliation":[{"name":"Department of Pediatrics Division of Neonatology Pediatric Intensive Care Medicine and Neuropediatrics Vienna Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Valentina","family":"Zwiauer","sequence":"additional","affiliation":[{"name":"Department of Pediatrics Division of Neonatology Pediatric Intensive Care Medicine and Neuropediatrics Vienna Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andreas","family":"Repa","sequence":"additional","affiliation":[{"name":"Department of Pediatrics Division of Neonatology Pediatric Intensive Care Medicine and Neuropediatrics Vienna Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christoph","family":"Binder","sequence":"additional","affiliation":[{"name":"Department of Pediatrics Division of Neonatology Pediatric Intensive Care Medicine and Neuropediatrics Vienna Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Natalja","family":"Haninger","sequence":"additional","affiliation":[{"name":"Department of Pediatrics Division of Neonatology Pediatric Intensive Care Medicine and Neuropediatrics Vienna Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bernd","family":"Jilma","sequence":"additional","affiliation":[{"name":"Department of Clinical Pharmacology Medical University of Vienna Vienna Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angelika","family":"Berger","sequence":"additional","affiliation":[{"name":"Department of Pediatrics Division of Neonatology Pediatric Intensive Care Medicine and Neuropediatrics Vienna Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nadja","family":"Haiden","sequence":"additional","affiliation":[{"name":"Department of Pediatrics Division of Neonatology Pediatric Intensive Care Medicine and Neuropediatrics Vienna Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2013,10]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0031-3955(05)70295-9"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.102.3.e38"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1136\/fn.70.2.F141"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1177\/089033402237909"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-3476(80)80729-3"},{"key":"e_1_2_7_7_1","doi-asserted-by":"crossref","unstructured":"KuschelCA HardingJE. 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