Use of fortified skimmed breast milk to feed infants with postoperative chylothorax

Guadalupe Lopez

Abstract

Background: Breast milk is the best source of nutrition for the infant but infants suffering from post-surgical chylothorax cannot consume breastmilk due to its high fat content. There is an interest among health care providers and mothers of infants with chylothorax to use skimmed, supplemented breast milk instead of specialized infant formulas.

Objective: The purpose of this study was to assess the nutritional intake, tolerance and growth of infants fed fortified skimmed breast milk compared to infants fed specialized infant formulas for the treatment of chylothorax following cardiothoracic surgery.

Study design: Expressed breast milk was skimmed by allowing it to sit undisturbed for at least 24 hours in the refrigerator to separate the fat and non-fat fractions. Skimmed breast milk contained inadequate energy for infants after cardiothoracic surgery so the skimmed breast milk was fortified with MCT ProCal™ (Vitaflo USA, Alexandria, VA) or Monogen™ (Nutricia North America, Gaithersburg, MD), medium-chain triglyceride containing supplements, to reach ~22 kcal/oz before feeding to the infant. Infant intake of total energy and protein, incidence of emesis and diarrhea and daily weights were recorded during the inpatient stay. Weight was recorded at follow up outpatient visits when infants were also assessed for reoccurrence of chylothorax.

Results: Eight infants with chylothorax were fed fortified skimmed breast milk and 9 infants were fed specialized infant formula following surgery. There was no difference in energy and protein intake per kg of body weight, no difference in incidence of emesis or diarrhea and no difference in weight gain between treatment groups.

Conclusion: Fortified skimmed breast milk offers potential benefits to mothers who wish to resume breast feeding after resolution of chylothorax and possibly for the infant in the form of the other benefits of breast milk over formula feeding. The refrigeration and syringe method to skim breast milk was an effective method to skim the breast milk. The use of fortified skimmed breast milk was therapeutically equivalent to specialized infant formulas in our study and may be an additional therapeutic option to successfully treat infants with chylothorax.