P1.222: Reducing Human Milk Nutrient Loss During Enteral Feeding Using an Engineering Approach

Background: Optimal nutrition in the neonatal intensive care unit (NICU) is essential for supporting growth and development in preterm infants. Breastmilk is the ideal source of nutrition for neonates, but preserving its complex nutritional characteristic is often challenging. Tube feeding, commonly used in the NICU, can result in lipid losses up to 59%, resulting to poor growth of preterm infants. Given that prematurity affects around 10% of live births, minimizing macronutrient loss in breastmilk, especially during feeding delivery, is critical to improving neonatal nutrition. This study aims to utilize an engineering-based approach using a servo motor-based agitation system to reduce macronutrient loss at the point of delivery to preterm neonates. Earlier servo based mixing prototypes produced a lot of noise which was a barrier to clinical implementation.

Methods: A laboratory based experimental analysis of enteral feeding (Fig. 1A) was done using deidentified unpasteurized milk to characterize the baseline macronutrient loss during infusion and gravity feeds in the Moog Infinity Orange 100 mL bag (Fig. 1B) and a Medela 30 mL syringe. A servo-controlled agitation system was integrated into the infusion feed setup and programmed to oscillate at 24 rpm to improve mixing (Fig. 2A). Macronutrient content was measured before and after delivery using a mid-infrared human milk analyzer. We evaluated the percent nutrient loss across feeding setup and duration to identify optimal conditions for nutrient delivery.

Results: Preliminary data showed macronutrient losses during the 30-minute infusion feed (Fig. 1A), with protein and lipid losses reaching approximately 13% and 10% respectively. In contrast, negligible losses ( < 2%) were observed during simulated one-minute gravity feeds using 6.5 Fr and 8.0 Fr tubes. The short one-minute duration feed, however, does not reflect typical NICU feeding practices. Notably, preliminary qualitative results using our agitation system (Fig. 2A &B), showed visibly reduced fat residue in the feeding bottle compared to the non-agitation set up suggesting an improved delivery. Additionally, the servo motor added increased the ambient noise level by 13 dBA.

Conclusion: Observable protein and lipid loss after a 30-minute infusion feed and the reduced fat residue with agitation highlights the need for technologies for improved nutrient delivery in the NICU. Our ongoing work will assess the impact of servo-driven agitation and in-line warming on improvement of nutrient delivery during enteral feeding. By targeting efficient macronutrient delivery, our approach would significantly improve nutrition in preterm infants, consequently improving growth trajectories and long-term developmental outcomes.