Problem-Solving: Enzymes in EBM that affect thickening


I am currently working in a Level 3 NICU and needing to thicken a baby’s formula to nectar. Baby was previously on fortified breastmilk, but I remember you saying at your course that breastmilk and oatmeal don’t bond. The neonatologist would like evidence. Do you have any suggestions where I can find this info?


It’s likely the Amylase (see below) — while its function when there is purely EBM from the breast is perfect, when additives for thickening are introduced in the EBM, it inhibits binding with oatmeal or rice cereal with the EBM. The oats and the EBM stay separated and therefore the EBM is not thickened.

See Enzymes Found in Breast Milk

There are many different enzymes found in breastmilk. These enzymes play an important role in the health and development of a newborn child. The enzymes in breast milk serve a variety of functions, some of which we do not even know yet. Some enzymes are necessary for the function of the breasts and the production of breast milk, some enzymes help a baby with digestion, and some are essential for a child’s development. Here are the most important enzymes found in breast milk.


Amylase is the main polysaccharide-digesting enzyme. It digests starch. Since babies are born with only a small amount of amylase, they can get this essential digestive enzyme through breast milk.


Newborns can fully digest and use the fat in breast milk because of lipase. Lipase breaks down milk fat and separates it into free fatty acids and glycerol. Newborns get energy from free fatty acids, and lipase makes those free fatty acids available before digestion occurs in the intestines.

Lipase is also responsible for the soapy, metallic smell that refrigerated or previously frozen and thawed breastmilk sometimes has. The cold temperatures and freezing and thawing of breast milk high in lipase can cause the fat in the milk to break down quickly leaving an unpleasant odor. It may not smell good, but the nutritional value is still good.


Protease speeds up the breakdown of proteins. There are high levels of protease in breast milk. It is believed that this enzyme is important for digestion especially during the period right after birth.


Lactoferrin is an iron-binding protein. It helps a baby absorb iron. Also, along with white cells and antibodies, lactoferrin kills bacteria. Lactoferrin stops E. coli from attaching to cells and helps to prevent infant diarrhea. Lactoferrin also prevents the growth of Candida albicans, a fungus. Lactoferrin levels are very high in preterm breast milk and the levels go down as lactation continues.


Lysozyme protects an infant against bacteria such as E. coli and Salmonella. The levels of lysozyme in the breastmilk rise especially around the time babies begin eating solid foods. The increase in lysozyme helps to protect children from germs that can cause illness and diarrhea.

I hope this is helpful.

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