346 - Comparison of Macronutrient Losses of Maternal Breastmilk vs. Pasteurized Donor Breastmilk via Enteral Feeding Systems in the NICU

Publication Number: 3333.346

Anna K. Paschall, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Tarah Colaizy, University of Iowa Stead Family Children's Hospital, Iowa City, IA, United States; Ting Ting Fu, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States

Background: Many infants in the NICU require enteral tube feeding. Significant macronutrient losses from breastmilk can occur with enteral feeding systems, especially fat. Optimizing nutrient delivery is crucial as fat is critical to rapid brain and lung growth during NICU hospitalization, with growth linked to neurodevelopment, and breastmilk reduces overall morbidity. Enteral tube feeds are often delivered via syringe pump or feeding bag systems; however, it is unknown whether nutrient loss differs between these systems or if the repetitive freeze-thaw cycles of pasteurization impact these losses.

Objective: To compare breastmilk macronutrient loss after delivery through syringe and feeding bag enteral feeding systems and between maternal breastmilk (MBM) and pasteurized donor breastmilk (PDM).

Design/Methods: Frozen unpasteurized MBM and pasteurized donor milk were combined into separate pools for analysis. Moog feeding bags and NeoMed 35 ml syringes were connected to extension tubing and a 6.5 French feeding tube for simulations. For each simulation, 20 ml of milk was delivered over gravity, 30, 60, 90, or 180 minutes (continuous feeds), for 10 pools each of MBM and PDM. Baseline and post-delivery macronutrient content was analyzed using a mid-infrared milk analyzer. Statistical analyses were performed using repeated measures ANOVA, Multiple Wilcoxon for paired data, or Mann-Whitney tests for unpaired data.

Results: Significant reductions in fat content and energy with prolonged feeding time (p < 0.0001) and use of a feeding bag was observed (p < 0.0001) (Fig. 1). No significant macronutrient differences were observed at each timepoint for MBM vs. PDM (Fig. 2). Table 1 shows mean changes in macronutrients per timepoint, with notable average loss of 38.3% (MBM) and 33.1% (PDM) of fat at 180 minutes with syringe pump compared to 54.5% (MBM) and 48.6% (PDM) with feeding bags.

Conclusion(s): Prolonged enteral feeding times results in significant losses in fat and energy of breastmilk, without significant changes in protein and carbohydrate content. Losses are greater with feeding bag systems compared to syringe pump systems. No significant differences in macronutrient losses were observed comparing MBM to PDM. Further work will investigate methods to mitigate loss of fat in enteral feeds to optimize growth of premature infants.

Table 1: Mean Macronutrient Change from Baseline over Infusion Time
n=10 for each simulation

Figure 1: Comparison of Fat and Energy Change from Baseline Syringe Pump vs. Feeding Bag
* Indicates p<0.05 via Multiple Wilcoxon; nd indicates no statistically significant difference. Fat and energy losses also increased with prolonged feeding time (repeated measures ANOVA, p<0.0001).

Figure 2: Mean Macronutrient Changes from Baseline Per Infusion Time Point
MBM, maternal breastmilk; PDM, pasteurized donor milk.