Assessing growth of infants with chylothorax receiving fortified skimmed human breast milk.

LEARNING OUTCOME To learn how skimmed human milk (SHM) can be used in infants with chylothorax to support adequate weight gain and nutrition while receiving human milk. BACKGROUND Traditional nutrition management for chylothorax is to limit long-chain triglycerides (LCTs) and provide a diet high in medium-chain triglycerides (MCTs). Transition from human milk to formula has been required to provide the ratio of MCT to LCT required to stop the accumulation of chyle. Although SHM may provide the right fat content for a baby with chylothorax, previous studies have shown slow growth in infants receiving SHM. OBJECTIVE To demonstrate that infants receiving SHM fortified with high-MCT infant formula will have age appropriate growth without re-accumulation of chyle. DESIGN/METHODS Between 2017 and 2019, term infants with the diagnosis of chylothorax who were previously receiving human milk and transitioned to fortified SHM were monitored for growth and reaccumulation of chyle. RESULTS The six infants who were prescribed fortified SHM with high-MCT infant formula using standardized recipes did not show reaccumulation of chyle and showed positive weight gain in five of the six study patients. The infants gained a mean weight of 30.5 g/day (±19.5), and their weight z scores improved by a mean of +0.29 (±0.33). CONCLUSIONS Fortified SHM is a safe treatment option that can provide adequate nutrition for the infant with chylothorax to gain weight appropriately for age.

[1]  M. B. McCoy,et al.  In-Hospital Formula Feeding and Breastfeeding Duration , 2020, Pediatrics.

[2]  E. Polzin,et al.  Implementation of the Use of Skimmed Breast Milk and the Registered Dietitian Nutritionist's Role. , 2019, Journal of the Academy of Nutrition and Dietetics.

[3]  D. O’Connor,et al.  Fat-Modified Breast Milk Resolves Chylous Pleural Effusion in Infants With Postsurgical Chylothorax but Is Associated With Slow Growth. , 2016, JPEN. Journal of parenteral and enteral nutrition.

[4]  D. DellaValle,et al.  Feasibility and Efficacy of Defatted Human Milk in the Treatment for Chylothorax After Cardiac Surgery in Infants , 2016, Pediatric Cardiology.

[5]  N. Thomas.  Nutritional care of preterm infants: Scientific basis and practical guidelines , 2016, The Indian Journal of Medical Research.

[6]  J. Schulte‐Mönting,et al.  Chylothorax after surgery on congenital heart disease in newborns and infants -risk factors and efficacy of MCT-diet , 2010, Journal of cardiothoracic surgery.

[7]  Betty R. Vohr,et al.  Persistent Beneficial Effects of Breast Milk Ingested in the Neonatal Intensive Care Unit on Outcomes of Extremely Low Birth Weight Infants at 30 Months of Age , 2007, Pediatrics.

[8]  G. Chan,et al.  The use of fat-free human milk in infants with chylous pleural effusion , 2007, Journal of Perinatology.

[9]  R. Baker.  Infant formula safety. , 2002, Pediatrics.

[10]  S. Leonard,et al.  Removal of fat from Cow's milk decreases the vitamin E contents of the resulting dairy products , 2001, Lipids.