Comparison of Lipid and Calorie Loss From Donor Human Milk Among 3 Methods of Simulated Gavage Feeding

Abstract

Unlike gravity feedings, the timed feedings resulted in a statistically significant loss of fat as compared with their controls. These findings should raise questions about how those infants in the neonatal intensive care unit are routinely gavage fed.

Improved Delivery of Fat From Human Breast Milk via Continuous Tube Feeding

“…Maximum fat losses, amounting to an average of 73% over the 4‐hour infusion, were seen at lower rates of infusion (5 mL/h). These results are in agreement with previously conducted studies, most of which use syringe pumps 7 , 10 , 11 , 27 . In addition, these studies were intended to replicate NICU practices where feeds are administered over 30–90 minutes rather than in a continuous fashion over a longer period of time (typically over 4 hours).…”

“…Despite existing evidence and recommendations, a recent study found that only 19% of intestinal rehabilitation programs were using human milk 18 . One reason of the lack of use of human milk, even if available and well tolerated by the infant, is the observation that continuous tube feeds result in a loss of lipid and calorie content of human milk and could potentially affect weight gain and growth of the infant, leading to longer hospital stay 7 – 10 , 25 …”

“…Moreover, some of the patients tolerate continuous tube feeding better than bolus feeds. Neonatal intensive care unit (NICU)–based in vitro studies done in the 1980s and more recent studies have demonstrated fat and total calorie losses with tube feeding when human milk was used, the losses being the greatest with continuous feeds and with longer tube lengths 1 , 7 – 11 . Although the above‐mentioned studies provide convincing evidence for fat and calorie losses associated with continuous tube feedings, they differ substantially from the feeding practices in intestinal rehabilitation patients on the inpatient floors and in the home settings.…”

Is fat content of human milk decreased by infusion?

“…We performed the second study to determine whether the size of the tubes, their material, or the duration of tube infusion made any difference to the loss of fat content with tube infusion. There is a report that timed tube feeding (1 or 2 h) resulted in loss of fat content in donor HM, but that gravity feeding did not . Another report showed that nutrients (fat, protein, calcium and phosphorus) were maintained at higher levels with more rapid infusion (gravity bolus, drip over 10–15 min) .…”

“…Tube infusion for very preterm infants is necessary because they are not able to feed orally. Previous studies have concluded that tube infusion could decrease the fat content in HM . Decreases in fat content have also been reported with donor HM, and with thawed HM .…”