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Comparison of Lipid and Calorie Loss From Donor Human Milk Among 3 Methods of Simulated Gavage Feeding: One-Hour, 2-Hour, and Intermittent Gravity Feedings

Brooks, Christine MSN, RNC-NIC, NE-BC; Vickers, Amy Manning BSN, RN, IBCLC; Aryal, Subhash PhD

Section Editor(s): Dowling, Donna

doi: 10.1097/ANC.0b013e31827e225b
Original Research

PURPOSE: The objective of this study was to compare the differences in lipid loss from 24 samples of banked donor human milk (DHM) among 3 feeding methods: DHM given by syringe pump over 1 hour, 2 hours, and by bolus/gravity gavage.

DESIGN: Comparative, descriptive. There were no human subjects.

METHODS: Twenty-four samples of 8 oz of DHM were divided into four 60-mL aliquots. Timed feedings were given by Medfusion 2001 syringe pumps with syringes connected to narrow-lumened extension sets designed for enteral feedings and connected to standard silastic enteral feeding tubes. Gravity feedings were given using the identical syringes connected to the same silastic feeding tubes. All aliquots were analyzed with the York Dairy Analyzer. Univariate repeated-measures analyses of variance were used for the omnibus testing for overall differences between the feeding methods. Lipid content expressed as grams per deciliter at the end of each feeding method was compared with the prefed control samples using the Dunnett's test. The Tukey correction was used for other pairwise multiple comparisons.

RESULTS: The univariate repeated-measures analysis of variance conducted to test for overall differences between feeding methods showed a significant difference between the methods (F = 58.57, df = 3, 69, P < .0001). Post hoc analysis using the Dunnett's approach revealed that there was a significant difference in fat content between the control sample and the 1-hour and 2-hours feeding methods (P < .0001), but we did not find any significant difference in fat content between the control and the gravity feeding methods (P = .3296). Pairwise comparison using the Tukey correction revealed a significant difference between both gravity and 1-hour feeding methods (P < .0001), and gravity and 2-hour feeding method (P < .0001). There was no significant difference in lipid content between the 1-hour and 2-hour feeding methods (P = .2729).

CONCLUSIONS: Unlike gravity feedings, the timed feedings resulted in a statistically significant loss of fat as compared with their controls. These findings should raise questions about how those infants in the neonatal intensive care unit are routinely gavage fed.

Texas Health Presbyterian Dallas Neonatal Intensive Care Unit (Ms Brooks); Mothers' Milk Bank of North Texas, Ft Worth (Ms Vickers); and University of North Texas Health Science Center, Ft Worth, Texas (Dr Aryal).

Correspondence: Christine Brooks, MSN, RNC-NIC, NE-BC, Texas Health Presbyterian Dallas Neonatal Intensive Care Unit, 8200 Walnut Hill Ln, Dallas, TX 75231 (

The authors thank the study team of the neonatal intensive care unit at Texas Health Dallas and the North Texas Milk Bank of Ft Worth for making this original research possible through both their donation of time and donor breast milk.

The authors declare no conflict of interest.

© 2013 National Association of Neonatal Nurses