Abstract
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.
Highlights
Continuous infusion resulted in an average fat loss of 40%
A significant decrease of fat content was seen between the continuous feeding simulasignificant of fat content was seenHowever, between the continuous feeding simutionsA
That, when the breast milk fat emulsion separates et, thehypothesis fat rises owing density findings directly oppose those of Narayanan al. [9]
Summary
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. Narayanan et al demonstrated that tilting the feeding pump at an angle between 25 and 40 degrees with an eccentric nozzle is the most successful method of reducing lipid losses, with a fat loss of as little as 7.1% occurring with the pump tilted [9]. The slower the flow rate of a continuous feeding, the higher the fat loss, indicated by the results of Stocks et al [10], and effects after heating, freezing, refrigeration, and tube feeding, discussed by Tacken et al [11]
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