Breastfeeding/Human Milk 1: Human Milk in the NICU
362 - Breast milk macronutrient analysis of mid-day pump sample versus 24-hour pooled sampling
Friday, April 28, 2023
5:15 PM – 7:15 PM ET
Poster Number: 362 Publication Number: 362.101
Vi-Van Nguyen, University of California, Davis, School of Medicine, Sacramento, CA, United States; Kathryn Wright, UC Davis Health, 1071 Rathbone Circle, CA, United States; Sarah Haynes, University of California, Davis, School of Medicine, Sacramento, CA, United States; Daniel J. Tancredi, University of California, Davis, School of Medicine, Sacramento, CA, United States; Kara Kuhn-Riordon, University of California Davis Children's Hospital, Sacramento, CA, United States
Medical Student University of California, Davis, School of Medicine Sacramento, California, United States
Background: The UC Davis Neonatal Intensive Care Unit (NICU)has a human milk analysis (HMA) program to improve the nutrition of high-risk neonates by enabling individualized fortification of human milk (HM). The consensus in current literature suggests a 24-hour sampling method (24P) as the gold standard for HMA; this method may be burdensome for highly stressed NICU parents. To encourage participation and minimize burden, our unit’s protocol is to analyze a 5mL HM sample from a midday pump (MDP) once weekly. This time of day was chosen to address the circadian variation of macronutrient composition in HM. Objective: Our aim is to determine if an MDP can approximate macronutrient composition of a 24P of HM and provide a representative sample of HM to utilize for individualized fortification. Design/Methods: Infants eligible for the study were <34 weeks at birth, with samples collected until 36 weeks. Exclusion criteria included infants receiving < 50% maternal HM or NPO status. Researchers provided collection kits for both sample methods with verbal and written instructions to participants. Samples were stored in a freezer until macronutrient analysis. The Miris Human Milk Analyzer was used to analyze energy, fat, protein, and carbohydrate composition in HM samples. Only paired 24P and MDP samples were included in the statistical analysis. We fit a panel data fixed effects model with participant ID as a fixed effect to estimate the within-person mean difference of the MDP and 24P samples. Results: 97 total samples were collected from the mothers of 37 infants. Of those, there were 31 pairs of a MDP and 24P collection samples. The MDP had statistically significant differences in calories (mean of 3.96 greater calories than 24P, 95% CI: 1.83-6.09, p< 0.01), fat (mean of 0.46g greater than 24P, 95% CI: 0.24-0.68, p=0.004), and protein (mean of 0.07g less than 24P, 95% CI: -0.12- -0.02, p=0.008).
Conclusion(s): To our knowledge, this is the first study that compares macronutrient composition between the gold standard 24P and MDP. Our study found statistically significant differences in total calories, fat, and protein content between these methods. Our results suggest that the MDP method may overestimate caloric value and fat content, which may result in under-fortification and suboptimal growth if solely used as a basis for individualized fortification. We recommend a 24P sampling,if usingHMA, as a guide for individualized fortification. The main limitation of this study was that samples were self-collected by participants and differences in individual sampling techniques may have impacted results.
