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How Syringe Choice Can Affect Lipid Delivery

If 10% of fat is lost before feeding, then 5% of available caloric energy is lost too

About 50% of the energy in human milk is from fat, and this is almost entirely accounted for by the milk triglyc­erides and their fatty acids. Triglycerides are the major form of fat in the diet and typi­cally provide 98% of the fat in human milk. Only 5% of HBM is fat and fat-soluble compo­nents, including many vita­mins. The other 95% is water and water soluble compo­nents. Each 10% loss of fat during enteral delivery repre­sents a 5% loss of avail­able caloric energy to the NICU infant, because about half of the energy avail­able in HBM comes from the fat. In addi­tion, crit­ical fat-soluble nutri­ents are not avail­able to the baby if the fat compo­nent of HBM is under-delivered.

Clinicians are concerned about nutri­tional loss during collec­tion, storage, and transfer of HBM. Research has iden­ti­fied systemic losses of fat and lipids during the enteral delivery process. Complex method­olo­gies are required to eval­uate the impact of multiple vari­ables on the outcome. In other words, the loss of fats in the HBM delivery model is well docu­mented, but the indi­vidual contri­bu­tion of fat loss for each compo­nent in the enteral delivery system has not been adequately studied to date.

How Syringe Choice Can Affect Lipid Delivery

Off-Center Tip

When used with a hori­zon­tally oriented pump, off-center syringe tips encourage delivery of lipids first. Centered syringe tips cause lipids to be deliv­ered last. The pump must be tilted or rotated to deliver lipids first with a center-tip syringe, which may void the warranty on the pump.

Rubber Plunger Head

Rubber plunger tips are more conical, creating more surface area for unwanted lipid/fat adhe­sion to the surfaces of both the plunger piston and the end of the syringe. The solid polypropy­lene plunger head is flatter, creating less surface area for unwanted lipid/fat adhe­sion.

Various studies have been done in an effort to quan­tify the fat (lipid), carbo­hy­drate, and volume loss asso­ci­ated with enteral delivery.

The Netherland study demon­strated loss of 33% triglyc­erides, 35% lutein, and 26% ß-Carotene in the enteral delivery system. The Netherland study goes further to state that triglyc­eride loss accounts for 16% of the total caloric intake of neonates. Neither study specif­i­cally addresses the impact of oil/lipid soluble micronu­tri­ents that are contained in the lost lipids nor the possible NICU impacts of growth and thriving, lung devel­op­ment, eye devel­op­ment, cogni­tive devel­op­ment, or other phys­i­o­log­ical attrib­utes. One thing is certain: fat loss reduces nutrient delivery and energy avail­ability.

The impor­tance of human breast milk (HBM) in the devel­op­ment of neonates and infants is well estab­lished. Lois Arnold, in Human Milk in the NICU iden­ti­fies several bene­fits of human milk for the preterm infant, summa­rized below:

Disease Protection

HBM delivers immunoglob­u­lins, lacto­ferrin, and lysozyme. It also contains complex carbo­hy­drates such as mucins, oligosac­cha­rides, glycans, and others that prevent bacte­rial and para­sitic adhe­sion.

Gut Development

HBM coats and protects the gut with high levels of immune proteins and anti­bodies, contains growth factors to support growth of absorp­tive cells found in the gut lining, supports gut closure, and reduces perme­ability to pathogens.

Digestibility

Premature babies can absorb 95% of human milk fat. HBM has the appro­priate compo­si­tion of digestible proteins, as well as supple­men­tary diges­tive enzymes. HBM contains enzymes that digest fat.