(36) Comparing Macronutrient Delivery Across Various Feeding Pumps in the NICU

Caitlin Irwin, Indiana University School of Medicine, Indianapolis, IN, United States; Beard Kate, Riley Hospital for Children, United States; Kok Lim Kua, Indiana University School of Medicine, United States; Huff Katie, Indiana University, United States

Background: Premature infants in the NICU have oromotor immaturity and often need breastmilk delivered through a feeding pump system. A known challenge of traditional syringe-feeding pumps is the loss of milk’s fat and calories. Bottle- and bag-feeding pumps are now increasingly used in many NICU settings, but there are limited studies evaluating the fat loss associated with the use of these feeding pumps.

Objectives: This study aims to compare the percentage delivery of fat, calories, carbohydrate and protein between a bottle-enteral feeding pump system and a bag-enteral feeding pump system.

Design/Methods: We compared 16mL samples of donor human milk (DHM) via a bottle-feeding pump system and a bag-feeding pump system over 15, 30, 60 and 90 minute durations. The DHM macronutrient and caloric content were measured using FDA-approved Human Milk Analyzer (MIRIS AB, Sweden) prior to infusion as baseline and immediately after completion of each simulation. Simulations were tested 9 times at each rate. Percent changes of macronutrients and calories of baseline were calculated and statistical differences were determined using one-way ANOVA.

Results: Fat and calorie content of DHM was significantly reduced during 15 minute feeds with the bag system and during 30 minute, 60 minutes and 90 minute feeds for both the bottle and bag systems (Figures 1,2). Carbohydrate delivery was reduced with 90 minute feeds using a bag system (Figure 3). There was no difference in protein delivery (Figure 4). The percentage of fat delivered was significantly less when using the bag system as compared to the bottle system for 15 minutes (96.5% bottle vs. 73.6% bag, p-value < 0.001), 30 minutes (82.4% bottle vs. 62.1% bag, p-value < 0.001), 60 minutes (60.1% bottle vs. 47.9% bag, p-value = 0.003) and 90 minutes (57.8% bottle vs. 37.3% bag, p-value < 0.001). The percentage of calories was also significantly different at all time points between the two feeding systems (Figure 2).

Conclusion: Enteral feeding pumps utilizing either a bag or a bottle result in a significant reduction in fat and calorie delivery when feeds are run for 30 minutes or longer; the fat and calorie delivery is improved when using a bottle feeding pump system as compared to a bag feeding pump system. Our results suggest the bottle system is superior at delivering critical macronutrients in the NICU and may be a simple way to improve fat and calorie delivery to the neonate.