Delivering Full Human Milk Nutrition in the NICU: Part 3
Are you focused on improving nutrition in your NICU? Does your unit have a feeding committee that is focused on optimizing human milk delivery? If there was one change you could make in your current practice to improve fat delivery by 40%, would you be willing to make that change?
If so, you are NOT alone, and the following information is for you.
Human milk is the normative standard for infant feeding and nutrition for premature and term infants.1 It becomes critically important, especially in the NICU, to preserve the fat and nutrients for growth and development of premature infants. Unfortunately, fat and nutrients can be lost when human milk is delivered using an enteral feeding infusion pump for continuous or intermittent feeding over a period of time.
One of the most variable components of mother’s own milk and donor human milk is the fat content. The Human Milk Banking Association of North America (HMBANA) is an organization that has published best practice recommendations for human milk storage and handling, and provides strategies for minimizing the loss of fat and nutrients. They recommend “using a milk infusion system with the syringe tip pointed up”2 to reduce fat loss. The scientific evidence provides the rationale that “the fat portion of the milk rises to the top when the milk is sitting” in the syringe. “Using a feeding pump system with the syringe tip pointed up reduces fat loss from 48% to less than 8%”.2
Robbins and Meyers echo very similar guidelines for best practice by stating “tilting the delivery system so that the exit point of the feeding system is elevated minimizes the loss of fat.”3
I like this recommendation because it is straight forward and does not require a lot of variables. Instead, it is a fairly simple change in practice. Delivering enteral syringe pump human milk feeds with the syringe tip in the near-vertical or vertical position will allow fat to rise and be delivered first to the infant. Just imagine the consistency of having all babies receive more fat and nutrients, and the impact it could have on infant growth, if this practice was adopted by an entire unit.
Most importantly, the benefit of this solution is that there is no need to purchase a specific type of syringe, or ensure that the syringe is on the pump in a specific orientation, or try to determine if it is at 30-45 degree range.
If you don’t already have the ability to rotate your enteral feeding pumps on their poles, you might want to consider available options. The key is to avoid potential mishaps that can occur when using “home-grown” methods of propping a pump. There are risks associated with manually propping a syringe pump to an angle. It could fall off whatever was used to prop it in place, and perhaps drop to the floor (or worse, fall on a baby). Placing the syringe pump in the vertical position on a pole takes the guess work, and the risks, out of the process.
If you are looking at ways to enhance fat delivery in your unit, evaluate your enteral feeding pumps! There are three ways to do this:
- Verify if the enteral feeding syringe infusion pumps on your unit are designed to infuse in the vertical position.
- Make sure you have enough pole clamps for them (the pole clamps are often the mechanism for rotating). Oftentimes they are not permanently attached to the pumps and may be in the supply room or hiding in various locations.
- If you are unable to locate the pole clamps, consider contacting your enteral feeding syringe pump vendor to obtain additional parts.
I know you are passionate about delivering as much fat and nutrients as possible to babies in your unit. Let us know more about your current practice: do you already rotate your enteral syringe pumps? How do you encourage consistent practice in your unit?
Learn more about the Medela Enteral Feeding Pump and its rotating pole clamp.
- American Academy of Pediatrics. Policy Statement: Breastfeeding and the use of human milk.
- Jones, F. Best practice for expressing, storing and handling human milk in hospital, homes and child care settings Human Milk Banking Association of North America. (3rd). 2011.
- Robbins, S. and Meyers, R. Infant Feedings: Guidelines for preparation of human milk and formula in health care facilities. American Dietetic Association. (2nd). 2011.