Loss of breast milk nutrients during tube feeding.

Abstract

At this time the patient's serum lactate, pyruvate, folate, red blood cell folate serum B12, zinc, copper, cholesterol, and the lipoprotein values were all normal. Activities of alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, and y-glutamyltransferase were raised.After supplementation with vitamin E for 6 months the nystagmus had resolved. After 18 months of treatment the ataxia had lessened, hand coordination was improved, and Romberg's sign was negative. She was still areflexic. DiscussionA neurological syndrome secondary to vitamin E deficiency which has responded to vitamin E supple-, ments has been reported in adults with cystic fibrosis.4 5 Our patient resembled these previous reports but presented much earlier. This was presumably because of impaired bile salt solubility of the vitamin in addition to pancreatic insufficiency. Luminal bile salt concentrations were likely to have been reduced in our patient. Firstly she had multiple resections of the ileum, the site of the active reabsorption of bile salts; secondly, the situation would be exacerbated by stasis in the dilated jejunum producing a 'blind loop' effect; and finally biliary fibrosis would result in impaired biliary excretion.Although this neurological complication seems to be relatively uncommon in cystic fibrosis, it is important to be aware of it. A careful neurological examination of these patients for evidence of cerebellar, posterior column, and peripheral nerve dysfunction is emphasised. Monitoring of serum vitamin E concentrations in all patients would be ideal and is recommended if possible, yet limited laboratory facilities for measurement make this impractical for many paediatricians. In patients with cystic fibrosis, 50 to 400 mg daily of a water miscible product has generally resulted in normal plasma and tissue levels of ct-tocopherol.' 3 6 In the absence of laboratory facilities regular vitamin E supplementation of a water miscible preparation of vitamin E is recommended in a dosage of 100 to 200 mg daily.

Leptin Levels in Preterm Human Breast Milk and Infant Formula

“…Although others 16 showed that fat sticks to the nasogastric tubing, the more recent work of Mehta et al 17 showed that milk fat does not stick. One possible explanation for this difference is that Stocks et al 16 used banked, pasteurized breast milk, whereas Mehta et al 17 used unpasteurized PBM. Pasteurizing the milk most likely disrupted the milk fat globules, allowing the fats to adhere to the tubing.…”

“…We speculate that this difference is because of irreversible denaturation of leptin by heat. Although others 16 showed that fat sticks to the nasogastric tubing, the more recent work of Mehta et al 17 showed that milk fat does not stick. …”

“…Leptin in term human breast milk is associated with milk fat globules. 13 Although Stocks et al 16 found that the fat in pasteurized, human breast milk adheres to the lining of the feeding tube, Mehta et al 17 showed that the fat in fresh milk does not. Thus, pasteurization and tube-feeding practices may affect the delivery of leptin to the infant.…”

Breastmilk ghrelin, leptin, and fat levels changing foremilk to hindmilk: is that important for self-control of feeding?

“…Leptin levels may be low in formula that is prepared using pasteurized low-fat milk. Additionally, breast milk nutrients are lost during tube feeding [42]. Thus, leptin and/or ghrelin pass through the baby (via the formula) and remain low.…”

Human milk and the premature infant

“…16,17 compared to refrigerated milk. [18][19][20] Pasteurization leads to denaturation of bile salt-stimulated lipase which reduces fat digestion which in turn leads to poorer weight gain with additional losses of calcium and phosphorus as insoluble soaps. Both drip milk and foremilk are low in energy as previously stated.…”