633 - Evaluation of Macronutrient Delivery of Human Milk Fortified with Liquid Protein and MCT Oil

Publication Number: 633.5032

Zachary Chad. Pinkard, University of Tennessee Health Science Center College of Medicine, Memphis, TN, United States; Mohamad Elabiad, University of Tennessee Health Science Center College of Medicine, Memphis, TN, United States

Background: Recently, customized targeted macronutrient fortification has become more common with Liquid Protein (LP) and medium-chain triglyceride (MCT) oil being some of the more common additives. However, some macronutrient losses have been shown to develop during continuous feeds. Previously reported problems included reduced delivery of human fortifier (HMF) and adsorption of fat to the tubing. It is not known if adding LP and/or MCT is associated with any macronutrient losses.

Objective: The objective of this study was to evaluate for macronutrient losses by comparing macronutrient levels between the prepared milk fortified with either LP or with MCT oil and the macronutrient levels in the delivered milk.

Design/Methods: In an in vitro study, commercially available LP and MCT oil were used. Donor milk (DM) at 22kcal/oz was fortified to 26kcal/oz using HMF. Milk volumes were based on an intake of 150 ml/kg/day. Milk samples fortified with LP targeted a protein load of 4.6 g/kg/day. Those with MCT oil targeted 28/kcal/oz. The syringe was positioned with the tip pointing upwards. At the end of a 3-hour infusion, prepared milk was compared to delivered milk. Miris human milk analyzer was used to measure the macronutrient levels of the samples. Paired T-test comparisons were done to evaluate the effect of LP and MCT oil across samples. Based on our previous studies, a sample of 10 runs were used, 5 with Liquid Protein and 5 with MCT oil.

Results: LP fortifications showed consistent delivery. There was a significant increase in the protein level from DM+HMF to DM+HMF+LP (prepared). However, there was no significant difference between DM+HMF+LP (prepared) and DM+HMF+LP (delivered), figure 1. With MCT oil, there was no significant increase in the fat level from DM+HMF to DM+HMF+MCT (prepared). There was also no significant difference between DM+HMF+MCT (prepared) and DM+HMF+MCT (delivered), figure 2. When adding MCT oil to fortified milk, it was noted that MCT oil would float and not stay in suspension after shaking, figures 3 and 4. MCT oil preparations did show slight but significant variations between prepared and delivered protein levels, figure 2.

Conclusion(s): In continuous feeds, Liquid Protein fortifications show consistent delivery of intended protein content. MCT oil does not remain in solution and shows evidence of separation and floating. MCT oil may not be delivered as intended, particularly if added to large batches of feeds or if prepared in advance of feeding time. There is a possibility that if milk batches are not prepared to the exact volume, any leftover milk would have most of the additive MCT oil.

Figure 1 and Figure 2


Figure 3
MCT separation in the collection cup

Figure 4
MCT separation in the infusion tubing