Growth of cardiac infants with post-surgical chylothorax can be supported using modified fat breast milk with proactive nutrient-enrichment and advancement feeding protocols; an open-label trial

Abstract

Background & aim: Previously we showed that modified fat breast milk (MFBM) facilitated resolution of post-surgical chylothorax in cardiac infants, but their weight-forage and length-forage z-scores declined over the !6-week treatment duration. Our aim was to evaluate the growth of infants diagnosed with post-surgical chylothorax and fed according to one of two proactive feeding protocols using MFBM or a high medium triglyceride (MCT)-containing formula (standard of care). Methods: In this open-label trial, infants who were receiving >50% of their enteral feeds as breast milk prior to chylothorax diagnosis were randomized to receive their enteral feeds according to one of two proactive MFBM protocols: Target Fortification (n ¼ 8), where the protein concentration of defatted breast milk was measured weekly and multi-and single-nutrient modulars were added to provide 3.5 g/kg/day of protein; or Higher Initial Concentration (n ¼ 8), where defatted breast milk was initially fortified to an energy and nutrient level higher than that of unmodified breast milk (80kcal/100 ml; 2.2 g/100 ml protein). A third nonrandomized group of infants (n ¼ 8) received high MCT formula (68kcal/100 ml; 2.3 g/100 ml protein). The intervention lasted for a minimum of 6-weeks after chest tube removal and continued after discharge. Weekly weight, length and head circumference (HC) measurements were completed. Results: At enrolment, there was no statistically significant differences in mean (±SD) weight-forage (À1.6 ± 0.9, n ¼ 24), length-forage (À1.3 ± 0.8), or HC-forage (À0.9 ± 1.0) z-scores among groups. Changes in mean weight-(À0.3 ± 0.9, n ¼ 23), length-(0.1 ± 0.6) and HC-forage (0.2 ± 0.6) z-scores did not differ among groups over the treatment period. There was no difference in duration or volume of chest tube drainage across groups. Conclusion: Use of proactive MFBM feeding protocols both resolve chylothorax and support growth in infants following cardiothoracic surgery. Trial registration: ClinicalTrials.gov (NCT02577419).

Etiological factors and treatment of chylothorax in paediatric patients - a systematic review

“…[49], [51-52], [54-58], [60-64], [66], [70][71][72][73][74][75][76][77][78][79][80][81], [84][85][86][87][88], [90][91][92][93], [95][96][97][98][99][100][101][102][103].…”

Chylothorax in the neonate—A stepwise approach algorithm

“…Breast milk can be centrifuged and converted into low‐fat breast milk, which can be supplemented with MCT 31–34 . In a study by Di Lauro et al, 31 there were no statistically significant differences in the duration or volume of chest drainage between patients who respectively received MCT and low‐fat breast milk 31 .…”

“…A challenge of the enteral diet of patients with chylothorax is to offer a long‐chain triglyceride‐free supply, and to ensure adequate nutrition for their weight growth and development. Thus, to complement conservative treatment, enteral dietary schemes must be created and adapted to the conditions of each service, clinical conditions, and the food tolerance of each patient 28,30,31 …”

“…Breast milk can be centrifuged and converted into low‐fat breast milk, which can be supplemented with MCT 31–34 . In a study by Di Lauro et al, 31 there were no statistically significant differences in the duration or volume of chest drainage between patients who respectively received MCT and low‐fat breast milk 31 . The accuracy of a creamatocrit in determining the total lipid content of a breast milk sample is approximately 90%, making it an accessible methodology that is fast and easy to use 35,36 .…”

Current Strategies to Optimize Nutrition and Growth in Newborns and Infants with Congenital Heart Disease: A Narrative Review

“…Because of the high level of long-chain triglycerides in human milk, this usually results in the discontinuation of breastfeeding. Modified breast milk that has undergone fat removal, with low fat content (LFBM), has been shown to be an efficient treatment for chylothorax, providing the benefits of human milk equally in those who cannot receive it [ 84 , 85 ]. Furthermore, changes in mean weight, length and head circumference for age Z-scores did not differ among infants nourished with defatted breast milk and infants receiving high-MCT formulas [ 85 ].…”