Calorie and Protein Intake of Very Low Birth

Calorie and Protein Intake of Very Low Birth Weight Infants When the Nutrient Composition of Breast Milk is Measured by Human Milk Analysis M. Newkirk MS RDN CSP LD, 1, 2 R. Brody Ph. D RD LD CNSC, 1 F. Shakeel MD, 2 P. Parimi MD, 2 P. Rothpletz-Puglia Ed. D RD, 1 R. Patusco, MS RD CSP, 1 A 1 Marcus Ph. D MPH 1 Department of Nutritional Sciences Graduate Programs in Clinical Nutrition, School of Health Professions, Rutgers University, Newark, New Jersey 2 Maternal, Fetal, Neonatal Institute, Johns Hopkins All Children’s Hospital, St. Petersburg, Florida Background • Human milk (HM) is ideal for enteral feeding very low birth weight (VLBW) infants. • Donor breast milk (DBM) is used when mother’s own milk (MOM) is not available. • Various fortification strategies are available to increase the calorie and protein content in HM to reach the ESPGHAN target of 110 -135 kcals/kg and 3. 5 -4. 5 g protein /kg. • A breast milk analyzer facilitates accurate determination of the baseline calorie and macronutrient content of HM in order to reach the Purpose recommended calorie and protein goals. To compare the actual calorie and protein intake on days VLBW infants were fed either fortified MOM or DBM relative to established nutritional recommendations and to determine if there were differences between the groups. Methods Design • Ancillary study of an existing data set of VLBW infants receiving MOM or DBM in which calorie and protein composition of HM was measured from a pooled 24 hour feeding period using the Calais HM Analyzer. • All HM was blindly fortified to at least 24 kcals/ounce with additional protein added. Data Collection • Data collected included milk source (MOM or DBM), baseline calorie and protein content of HM, type and amounts of fortifiers added, volume of enteral feedings and weight of the infant to measure total enteral calorie and protein intake. Statistical Analysis • Enteral feeding days of MOM and DBM were compared using the independent samples t-test. The one sample t-test was used to compare mean daily calorie and protein for both milk types to the Study Sample minimum target goals. A p-value < 0. 05 was considered statistically significant. 29 VLBW Infants • mean gestational age at birth: 28. 9 ± 1. 6 weeks • mean birth weight: 1153. 0 ± 220. 0 grams 145 days of enteral feedings • 78 (53. 8%) from DBM and 67 (46. 2%) from MOM Results Table 1 Calorie and protein content of DBM and MOM prior to and after all fortifiers added. In the DBM group, 18 of 78 days (23. 1%) and 12 of 67 days (17. 9%) from the MOM group were fortified to > 24 kcals/ounce based on assumed baseline calorie content of HM. DBM (n=78) MOM (n=67) Mean ±SD Range Results based on HM Analysis Kcals /30 ml 18. 2 ± 1. 5 14. 8 -22. 9 19. 5 ± 4. 0 12. 8 -38. 1 (ounce) Kcals /100 ml 60. 6 ± 5. 1 49. 3 -76. 3 65. 3 ± 13. 2 42. 5 -127 g protein/100 1. 1 ± 0. 1 0. 9 -1. 6 1. 1± 0. 1 0. 8 -1. 1 ml Results after all fortifiers added Kcals /30 ml 21. 9± 1. 7 18. 4 -27. 1 23. 1± 4. 0 16. 5 -41. 4 (ounce) Kcals /100 ml 73. 2 ± 5. 7 61. 2 -90. 2 77. 0 ± 13. 2 55. 0 -138. 1 g protein/100 2. 7 ± 0. 2 2. 0 -3. 2 2. 7 ± 0. 2 2. 1 -3. 0 ml Table 3 Comparison of mean daily calorie and protein intake with ESPGHAN Milk Type recommendations. Kcals/kg DBM 110. 2 MOM 113. 0 g protein/kg DBM 4. 1 MOM 4. 0 g protein/kg ml/kg 113. 0± 21. 0 75. 3 -195. 2 DBM 4. 1± 0. 5 2. 7 -4. 9 MOM 4. 0± 0. 5 2. 6 -5. 4 DBM MOM * Denotes statistical significance 150. 7± 7. 6 126. 3 -173. 9 146. 8± 11. 3 116. 7 -193. 3 ESPGHAN Needs p 110 -135 0. 876 0. 242 3. 5 -4. 5 <0. 0001* Figure 1 Table 2 Comparison of daily intake for calories/kg, grams protein/kg and volume intake in ml/kg for DBM vs MOM. Nutrient intake was comparable between the two groups with statistically significant higher volume of enteral feedings for DBM. Milk Type Mean ±SD Range p Kcals/kg DBM 110. 2± 9. 0 88. 5 -132. 6 0. 275 MOM Daily Intake Figure 2 0. 162 0. 016* • 46 of 78 DBM days (59. 0 %) and 30 of 67 MOM days (44. 8%) were below the minimum established calorie needs of 110 kcals/kg as seen in Figures 1 and 2. Conclusion • Fortified MOM and DBM provides comparable nutrient intake. • Calorie content of both milk types before and after fortification was lower than is assumed in clinical practice. • Protein needs were met with use of a high protein fortifier. • Both types of HM may fail to meet calorie needs with standard fortification and feeding volumes which may lead to cumulative energy deficit during NICU stay. • A subset of study patients required higher calorie fortification to meet minimum energy needs and Disclosures: Original research was supported in part by a grant from Abbott Nutrition.