# EGF and IgA in maternal milk, donor milk, and milk fortifiers in the neonatal intensive care unit setting

## TL;DR

This study compares the levels of EGF and IgA in neonates fed maternal milk, donor milk, or formula, showing that human milk sources provide higher concentrations of these beneficial factors.

## Contribution

The study reveals that human milk-derived fortifiers maintain higher EGF and IgA levels compared to bovine-based ones, impacting neonatal nutrition in NICU settings.

## Key findings

- Human milk (maternal or donor) provides significantly more EGF and IgA than formula.
- Human milk-derived fortifiers maintain higher EGF and IgA levels compared to bovine-based fortifiers.
- Diet choices and fortification methods affect the concentration of beneficial biomolecules in neonates.

## Abstract

Human milk contains a variety of factors that positively contribute to neonatal health, including epidermal growth factor (EGF) and immunoglobulin A (IgA). When maternal milk cannot be the primary diet, maternal milk alternatives like donor human milk or formula can be provided. Donor human milk is increasingly provided to infants born preterm or low birth weight with the aim to supply immunological factors at similar concentrations to maternal milk. We sought to assess the concentrations of human EGF and IgA in the diet and stool of neonates between exclusive maternal milk, donor human milk, or formula-based diets. Using a prospective cohort study, we collected samples of diet and stool weekly from premature and low birth weight neonates starting at 10 days postnatal through five weeks of life while admitted to a neonatal intensive care unit (NICU). Compared to formula, there was significantly more EGF in both the milk and the stool of the infants fed human milk. Donor milk pooled from multiple donors contained similar concentrations of EGF and IgA to maternal milk, which was also significantly more than formula diets. Maternal milk supplemented with a fortifier derived from human milk contained significantly more EGF and IgA compared to unfortified maternal milk or maternal milk supplemented with fortifier derived from bovine milk. Further analysis of human milk-derived fortifiers confirmed these fortifiers contained significant concentrations of EGF and IgA, contributing to an increased concentration of those factors that bovine milk-derived fortifiers do not confer. These findings illustrate how the choice of diet for a newborn, and even how that diet is modified through fortifiers or pasteurization before ingestion, impacts the beneficial biomolecules the infant receives from feeding.