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Fractionation of expressed milk for the selective collection of hindmilk by mothers who deliver premature infants Lalari, Vikki Valjeet

Abstract

Adequate weight gain is often difficult to achieve in premature infants due to illness, high energy requirements, and suboptimal intakes. Feeding strategies to enhance the energy and nutrient intake of premature infants fed small volumes are necessary for individualizing nutritional care and promoting optimal growth. One feeding strategy for premature infants fed maternal milk is to fractionate mothers' milk into foremilk (low fat milk) and hindmilk (high fat milk) with the subsequent feeding of the energy dense hindmilk fraction to promote weight gain. Published research on fractionating expressed milk for the selective collection of hindmilk is limited. The purpose of this study was to develop a fractionating protocol for the selective collection of hindmilk produced by mothers of premature infants. The basis of the fractionating protocol was to determine an acceptable method for separating expressed milk into foremilk and hindmilk. Three fractionating methods, based on the visual appearance of the milk, the milk expression time, and the volume of milk expressed, were compared for efficacy (change in fat content and adequacy of hindmilk volume) and practicality (subjective evaluation by mothers). The "Time" method was found to be the most acceptable and practical fractionating method for the selective collection of hindmilk. A regression equation for predicting the fat content of milk from the creamatocrit value (determined by the Creamatocrit Method) was developed using a large number of milk samples (n=155) with varying concentrations of fat. This equation, fat (g/100mL) = [0.572 x (creamatocrit value)] - 0.18, was found to be more suitable for estimating the fat content of milk in the present data set when compared to other published equations. The Crematocrit Method can be a useful clinical tool as part of a fractionating protocol for estimating the fat content of milk. This fractionating protocol is suitable for mothers who produce a sufficient quantity of milk (>125%) relative to their infant's prescribed enteral intake. The fractionating protocol developed in this study is applicable for a clinical or research setting as the basis of a hindmilk feeding strategy to promote weight gain in premature infants.

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