Human Milk Fat Loss Is Strongly Affected by Syringe Position During Tube Feeding in the NICU Population

Abstract Objectives Human milk is the recommended feeding for preterm infants. It is a dynamic, non-homogenized fluid. The most variable component is the fat content, which rapidly separates out when milk is allowed to sit. Fat from human milk is thought to adhere to the plastic syringe and tubing products used to administer tube feedings. The objective of this study was to identify best practices for tube feeding preterm infants to minimize nutrient loss from human milk during administration in the Neonatal Intensive Care Unit (NICU). Methods A study was conducted to investigate the effect of different tube feeding methods on the macronutrient content of donated unpasteurized (raw) frozen human milk samples. Tube feeding scenarios tested were: (1) 30 min pump syringe tip horizontal; (2) 30 min pump syringe tip up; (3) 4 hr pump syringe tip horizontal; (4) 4 hr pump syringe tip up; (5) 15 min gravity syringe tip down; (6) 30 min gravity syringe tip down; and (7) controls. Fat loss was calculated using paired “pre” and “post” samples (n = 51 pairs). Percent fat loss was compared for each scenario versus control. Results More fat was lost with syringe tip horizontal or down than with tip pointed up. Another contributing factor was the pump infusion time. Greatest fat loss occurred with the 4 hr pump syringe tip horizontal (average fat loss 13.1%), followed by: 4 hr tip up (8.3%); 30 min tip horizontal (6.7%); and 30 min tip up (3.4%). Fat loss via gravity drip was similar for 15 min (6.6%) and 30 min (5.7%), so the two gravity scenarios were combined into one. Fat loss for controls was small (1.5%). Except for the 30 min pump tip up scenario (P = 0.16), all the other scenarios had higher fat loss when compared to control (P-values <0.001). Conclusions These findings suggest that, for best delivery of fat, tube feedings of raw human milk given by pump should be run with the syringe tip pointed directly up and with the shortest infusion time that the infant will tolerate. In contrast to previous published studies, both 15 and 30 min gravity drip delivery resulted in more fat loss than 30 min pump infusion with syringe tip up. This difference may be due to the short gravity delivery times (<5 min) reported in prior studies. In our study, 15 and 30 min times were tested for gravity delivery to more realistically mimic those observed in routine NICU care. Funding Sources N/A.

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Feeding the feeble

10.1093/med/9780198854807.003.0038 ◽

2021 ◽

pp. 265-272

Author(s):

Michael Obladen

Keyword(s):

Human Milk ◽

Preterm Infants ◽

Necrotizing Enterocolitis ◽

Premature Infants ◽

Tube Feeding ◽

Theoretical Knowledge ◽

Air Inlet ◽

Nasogastric Tubes ◽

Nutritional Needs ◽

The 1960S

This chapter describes historic steps in feeding techniques and knowledge about the nutritional needs of premature infants. Devices to overcome weak sucking and swallowing were developed from 1851 to 1920: tube feeding by gavage, medicine droppers and pipettes, feeding bottles with air inlet, and beaked spoons for nasal feeding. Indwelling nasogastric tubes were in use from 1951. For alleged safety concerns, postnatal feeding was postponed until a week of starvation was reached in the 1950s and studies showed an association with neurological handicaps. The premature infant’s elevated need for energy, protein, and minerals has been known since 1919. However, nutritional practice lagged behind theoretical knowledge. Concentrated formula was developed in the 1940s, parenteral supplementation in the 1960s, and human milk fortifiers in the 1970s. In the 1990s, necrotizing enterocolitis was found to be more frequent in infants fed formula than in those fed human milk. Recently, probiotics were shown to reduce the risk of necrotizing enterocolitis. Compared to other aspects of neonatal medicine, there is little evidence on how to feed preterm infants.

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Ultrasonic Homogenization of Expressed Human Milk to Prevent Fat Loss During Tube Feeding

Journal of Pediatric Gastroenterology and Nutrition ◽

10.1097/00005176-198803000-00034 ◽

1988 ◽

Vol 7 (2) ◽

pp. 307 ◽

Cited By ~ 6

Author(s):

Margit Hamosh

Keyword(s):

Human Milk ◽

Tube Feeding ◽

Fat Loss

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Factors Influencing Breast Milk Fat Loss during Administration in the Neonatal Intensive Care Unit

Nutrients ◽

10.3390/nu13061939 ◽

2021 ◽

Vol 13 (6) ◽

pp. 1939

Author(s):

Mattias Paulsson ◽

Lena Jacobsson ◽

Fredrik Ahlsson

Keyword(s):

Intensive Care Unit ◽

Breast Milk ◽

Milk Fat ◽

Neonatal Intensive Care ◽

Tube Feeding ◽

Feeding Method ◽

Fat Loss ◽

Factors Influencing ◽

Before And After ◽

True Protein

The objective of this study was to investigate factors influencing fat loss during tube feeding of breast milk to preterm infants. An experimental study with 81 feeding simulations was performed, with nine continuous infusions in each of six modalities: Horizontal Higher, Horizontal Matched, Horizontal Lower, Tilted Higher, Tilted Matched, and Tilted Lower, and for comparison, 27 bolus feedings: nine flushed with air, nine with water, and nine that were not flushed, done at matched height. Each simulation utilized 16 mL of breast milk given over four hours. Continuous infusions were given with a flow rate of 4 mL/h. Bolus was given as 8 mL over the course of 15–20 min every other hour. Analysis for fat, true protein, carbohydrate, total solids, and energy was performed before and after each simulation. The percent of macronutrient loss was compared between all simulations. Continuous infusion resulted in an average fat loss of 40%. Bolus feedings resulted in an average fat loss of 11% (p ≤ 0.001). Considerable fat loss is seen during continuous tube feeding. Neither height in relation to the infant nor tilting of the pump reduce fat loss. To limit fat loss, the bolus feeding method should be utilized.

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Lecithin Decreases Human Milk Fat Loss During Enteral Pumping

Journal of Pediatric Gastroenterology and Nutrition ◽

10.1097/00005176-200305000-00004 ◽

2003 ◽

Vol 36 (5) ◽

pp. 613-615 ◽

Cited By ~ 10

Author(s):

Melissa M. Chan ◽

Masaru Nohara ◽

Benjamin R. Chan ◽

Julie Curtis ◽

Gary M. Chan

Keyword(s):

Human Milk ◽

Milk Fat ◽

Fat Loss ◽

Human Milk Fat

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Ultrasonic Homogenization of Expressed Human Milk to Prevent Fat Loss During Tube Feeding

Journal of Pediatric Gastroenterology and Nutrition ◽

10.1097/00005176-198707000-00018 ◽

1987 ◽

Vol 6 (4) ◽

pp. 593-597 ◽

Cited By ~ 33

Author(s):

F. E. Martinez ◽

I. D. Desai ◽

A. G. F. Davidson ◽

S. Nakai ◽

A. Radcliffe

Keyword(s):

Human Milk ◽

Tube Feeding ◽

Fat Loss

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Feeding the feeble: steps towards nourishing preterm infants

Journal of Perinatal Medicine ◽

10.1515/jpm-2014-0054 ◽

2015 ◽

Vol 43 (5) ◽

Cited By ~ 1

Author(s):

Michael Obladen

Keyword(s):

Human Milk ◽

Preterm Infants ◽

Necrotizing Enterocolitis ◽

Premature Infants ◽

Tube Feeding ◽

Theoretical Knowledge ◽

Air Inlet ◽

Nutritional Needs ◽

The 1960S ◽

Feeding Techniques

AbstractThis paper describes historic steps in feeding techniques and knowledge on the nutritional needs of premature infants. Devices to overcome weak sucking and swallowing were developed from 1851 to 1920, including tube feeding by gavage, medicine droppers and pipettes, feeding bottles with an air inlet, and beaked spoons for nasal feeding. Indwelling nastrogastric tubes were in use from 1951. For alleged safety concerns in the 1950s, postnatal feeding was postponed until a week of starvation was reached, and studies showed an association with neurological handicaps. The premature infant’s elevated need for energy, protein, and minerals has been established since 1919. However, these remained controversial, and nutritional practices continued to lag behind theoretical knowledge. Concentrated formula was developed in the 1940s, parenteral supplementation in the 1960s, and human milk fortifiers in the 1970s. In the 1990s, necrotizing enterocolitis was found to be more frequent in infants who were fed formula than in those who were fed human milk. Recently, probiotics were shown to reduce the risk of necrotizing enterocolitis. Nevertheless, compared with other aspects of neonatal medicine, there is still remarkably little evidence on how to feed preterm infants.

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Milk Fat Globule Glycoproteins in Human Milk and in Gastric Aspirates of Mother's Milk-Fed Preterm Infants

Pediatric Research ◽

10.1203/00006450-199810000-00006 ◽

1998 ◽

Vol 44 (4) ◽

pp. 499-506 ◽

Cited By ~ 63

Author(s):

Jerry A Peterson ◽

Margit Hamosh ◽

Ciaran D Scallan ◽

Roberto L Ceriani ◽

Theresa R Henderson ◽

...

Keyword(s):

Human Milk ◽

Preterm Infants ◽

Milk Fat ◽

Milk Fat Globule ◽

Mother's Milk ◽

Fat Globule ◽

Mother’S Milk

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Fat Loss in Continuous Enteral Feeding of the Preterm Infant: How Much, What and When is it Lost?

10.20944/preprints201806.0119.v1 ◽

2018 ◽

Author(s):

Carlos Zozaya ◽

Alba García-Serrano ◽

Javier Fontecha ◽

Lidia Redondo-Bravo ◽

Victoria Sánchez-González ◽

...

Keyword(s):

Fatty Acids ◽

Fatty Acid ◽

Human Milk ◽

Milk Fat ◽

Feeding Tube ◽

Gas Chromatography Mass Spectrometry ◽

Fat Loss ◽

Arachidonic Acids ◽

Human Milk Fat ◽

Long Chain

Human milk fat is a concentrated source of energy and provides essential and long chain polyunsaturated fatty acids. According to previous experiments, human milk fat is partially lost during continuous enteral nutrition. However, these experiments were done over relatively short infusion times, and a complete profile of the lost fatty acids was never measured. Whether this lost happens considering longer infusion times or if some fatty acids are lost more than others remain unknown. Pooled breast milk was infused through a feeding tube by a peristaltic pump over a period of 30 minutes and 4, 12 and 24 hours at 2 ml/hour. Adsorbed fat was extracted from the tubes, and the fatty acid composition was analyzed by Gas chromatography-mass spectrometry. Total fat loss (average fatty acid loss) after 24 hours was 0.6 ± 0.1%. Short-medium chain (0.7%, p=0.15), long chain (0.6%, p=0.56) saturated (0.7%, p=0.4), monounsaturated (0.5%, p=0.15), polyunsaturated fatty (0.7%, p=0.15), linoleic (0.7%, p=0.25), and docosahexaenoic acids (0.6%, p=0.56) were not selectively adsorbed to the tube. However, very long chain fatty (0.9%, p=0.04), alpha-linolenic (1.6%, p=0.02) and arachidonic acids (1%, p=0.02) were selectively adsorbed and therefore lost in a greater proportion than other fatty acids. In all cases, the magnitude of the loss was clinically low.

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