Human Milk Fat Loss Is Strongly Affected by Syringe Position During Tube Feeding in the NICU Population

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Current Developments in Nutrition



Human milk is the recommended feeding for preterm infants. It is a dynamic, non-homogenized fluid. The most variable component is the fat content, which rapidly separates out when milk is allowed to sit. Fat from human milk is thought to adhere to the plastic syringe and tubing products used to administer tube feedings. The objective of this study was to identify best practices for tube feeding preterm infants to minimize nutrient loss from human milk during administration in the Neonatal Intensive Care Unit (NICU). Methods

A study was conducted to investigate the effect of different tube feeding methods on the macronutrient content of donated unpasteurized (raw) frozen human milk samples. Tube feeding scenarios tested were: (1) 30 min pump syringe tip horizontal; (2) 30 min pump syringe tip up; (3) 4 hr pump syringe tip horizontal; (4) 4 hr pump syringe tip up; (5) 15 min gravity syringe tip down; (6) 30 min gravity syringe tip down; and (7) controls. Fat loss was calculated using paired “pre” and “post” samples (n = 51 pairs). Percent fat loss was compared for each scenario versus control. Results

More fat was lost with syringe tip horizontal or down than with tip pointed up. Another contributing factor was the pump infusion time. Greatest fat loss occurred with the 4 hr pump syringe tip horizontal (average fat loss 13.1%), followed by: 4 hr tip up (8.3%); 30 min tip horizontal (6.7%); and 30 min tip up (3.4%). Fat loss via gravity drip was similar for 15 min (6.6%) and 30 min (5.7%), so the two gravity scenarios were combined into one. Fat loss for controls was small (1.5%). Except for the 30 min pump tip up scenario (P = 0.16), all the other scenarios had higher fat loss when compared to control (P-values <0.001). Conclusions

These findings suggest that, for best delivery of fat, tube feedings of raw human milk given by pump should be run with the syringe tip pointed directly up and with the shortest infusion time that the infant will tolerate. In contrast to previous published studies, both 15 and 30 min gravity drip delivery resulted in more fat loss than 30 min pump infusion with syringe tip up. This difference may be due to the short gravity delivery times (<5 min) reported in prior studies. In our study, 15 and 30 min times were tested for gravity delivery to more realistically mimic those observed in routine NICU care. Funding Sources


Clinical Institute

Women & Children

Clinical Institute

Digestive Health