Does Feeding Previously Frozen (Thawed) Fortified Human Milk Increase the Incidence of Lactobezoar (Milk Curd) Obstruction? A Retrospective Cohort Study in One Large Neonatal Intensive Care Unit

Abstract

BackgroundCurrent recommendations suggest that it is appropriate to store human milk (HM) for up to 24 hours following fortification despite any changes that may occur in fortified HM over time. However, a recent publication suggested fortified frozen HM should be thawed and fed within 12 hours of fortification due to the risk of lactobezoar or milk curd obstruction. ObjectiveThis study investigated whether lactobezoar (milk curd) formation increased when frozen fortified HM was thawed and fed within 12 hours vs 12 to 24 hours postfortification in the neonatal intensive care unit (NICU) at Children’s Hospital of Orange County to determine if practice changes were warranted. DesignThis study was a retrospective cohort study. Participants/settingAll infants admitted to the Children’s Hospital of Orange County NICU for calendar years 2018-2019 who were fed fortified human milk (n = 802) were included in the study. Exposure variableFeedings using previously frozen (thawed) fortified HM. Main outcome measureLactobezoar or milk curd formation. Statistical analysisDescriptive analyses were used for statistical analysis. ResultsOf the 107,602 feedings prepared with fortified thawed HM, 68% (72,602) were used within 12 hours of preparation and 32% (34,499) were stored for 12 to 24 hours before administration. The NICU at Children’s Hospital of Orange County did not identify any lactobezoar formation or milk curd obstruction in either group. ConclusionsData from this study support recommendations for a maximum storage time for thawed, fortified HM of 24 hours.