Abstract
Continuous infusion systems used for enteral nutrition support in the neonatal intensive care unit deliver as little as 60% of the fat in human milk to the neonate. This study determined the effect of mixing common feedings for preterm infants in the feeding bag and tubing on fat losses during enteral feeding. Laboratory models were developed to assess the contribution of various mixing techniques to delivered fat content. Fat content was measured periodically during feeding and compared to baseline measurements. A multistage approach incorporating a feeding bag inverter and a tubing circulation loop delivered >90% of milk fat when used in conjunction with a commercial continuous infusion system. With unfortified human milk, this approach delivered 91.9% ± 1.5% of fat content over a one hour feed, significantly greater (p < 0.01) than 77.5% ± 2.2% delivered by continuous infusion controls (Mean ± SEM). With fortified human milk, this approach delivered 92.1% ± 2.4% of fat content, significantly greater (p < 0.01) than 79.4% ± 1.0% delivered by a non-adapted infusion system (Mean ± SEM). Mixing human milk during continuous infusion improves fat delivery, which may improve nutrition and growth outcomes in low birth weight neonates.
Highlights
Very low birth weight (VLBW) infants are commonly fed human milk enterally via gavage feeding [1,2,3]
Our results demonstrate that a combination of the two processes significantly reduces both endpoint and overall fat losses during one-hour feeds, improving energy and nutrient delivery compared to the current standard of care
We have demonstrated proof of concept that mechanical mixing in both the feeding bag and tubing can improve fat delivery of human milk in neonatal enteral feeding
Summary
Very low birth weight (VLBW) infants are commonly fed human milk enterally via gavage feeding [1,2,3]. Different methods of gavage feeding include intermittent gravity bolus and continuous infusion via a syringe or peristaltic pump. Despite the many advantages of feeding with human milk, slow growth rates in VLBW infants are common [2]. One factor which may contribute to this poor growth is the significant loss of fat from human milk during continuous infusion feeds, ranging from. Similar losses have been observed in human milk which has been supplemented with fortifier prior to feeding [9]. Since fat constitutes an important source of energy in feedings [6,10]
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