Breastfeeding/Human Milk 1: Human Milk in the NICU
358 - A Novel Approach to Improve Macronutrient Delivery of Donor Human Milk During Bolus and Continuous Feeds
Friday, April 28, 2023
5:15 PM – 7:15 PM ET
Poster Number: 358 Publication Number: 358.101
Caitlin Irwin, Indiana University School of Medicine, Indianapolis, IN, United States; Kate Beard, Riley Hospital for Children at Indiana University Health, Indianapolis, IN, United States; Kok Lim Kua, Indiana University School of Medicine, Indianapolis, IN, United States; Katie Huff, Indiana University School of Medicine, Indianapolis, IN, United States
Fellow Indiana University School of Medicine Indianapolis, Indiana, United States
Background: Human milk is the optimal nutrition for infants in the NICU. It is often delivered via a feeding pump, although a challenge of feeding pumps is reduced delivery of fat and calories due to separation of fat from other aqueous components in human milk. Our preliminary research showed intermittent manual mixing of milk during feeds resulted in improved fat and calorie delivery, thus identifying a possible feeding practice that maximizes nutrient delivery. Objective: We developed a bedside device that mixes breastmilk as it is delivered via a bottle-feeding pump system. We hypothesize that the continuous device-mixing of donor human milk (DHM) decreases gravitational separation of milk, resulting in improved fat and calorie retention during bolus and continuous feeds. Design/Methods: Our novel mixing device is a gear-driven device consisting of three gears (two counteracting gears driven by a single 1:2 ratio motor gear). A crossbeam is the main shaft piece connecting the counteracting gears to the bottle, allowing the bottle to continuously rock at a 55-degree angle in both directions from upright.
We performed an in-vitro study where 16mL samples of DHM were delivered via a bottle-feeding pump system over 30 min, 60 min, 90 min and 4 hour continuous rates. The in-vitro studies were repeated using the same volume and feeding rates with our novel mixing device. The DHM macronutrient and caloric content were measured using a Human Milk Analyzer (MIRIS AB, Uppsala, Sweden) prior to infusion as baseline and immediately after completion of each simulation. Percent of baseline were calculated and statistical differences were determined using one-way ANOVA.
Results: Fat and calorie content of DHM were significantly reduced during 30 min (fat 81.98±3.2%; calorie 90.6±2% of baseline), 60 min (fat 60.3±1.8%; calorie 79±1% of baseline), 90 min (fat 57.8±6.1%; calorie 77.8±3.5% of baseline), and 4 hour feeding rates (fat 42.2±1.4%; calorie 70.9±0.5% of baseline). Mixing of milk via the bedside mixing device resulted in modest improvement of fat delivery over 30 min (89.3±2.7% of baseline), 60 min (79.2±2.5% of baseline), 90 min (68.5±3.5% of baseline) and over 4 hours (51.2±1.25% of baseline), although improvement did not reach statistical significance.
Conclusion(s): Mechanical mixing of breastmilk during feeds utilizing a bottle-enteral feeding pump has the potential to improve macronutrient delivery. Our current prototype results in modest improvement of fat delivery, however increased sample size and further revisions to the device are necessary to significantly improve macronutrient delivery.
