title: Type of homogenization and fat loss during continuous infusion of human milk.
abstract: BACKGROUND
  Substantial fat loss may occur during continuous feeding of human milk (HM). A decrease of fat loss has been described following homogenization. Well-established methods of homogenization of HM for routine use in the neonatal intensive care unit (NICU) would be desirable.
  
  
  OBJECTIVE
  We compared the loss of fat based on the use of 3 different methods for homogenizing thawed HM during continuous feeding.
  
  
  METHODS
  Sixteen frozen donor HM samples were thawed, homogenized with ultrasound and separated into 3 aliquots ("baseline agitation," "hourly agitation," and "ultrasound"), and then frozen for 48 hours. Aliquots were thawed again and a baseline agitation was applied. Subsequently, aliquots baseline agitation and hourly agitation were drawn into a syringe, while ultrasound was applied to aliquot ultrasound before it was drawn into a syringe. The syringes were loaded into a pump (2 mL/h; 4 hours). At hourly intervals the hourly agitation infusion was stopped, the syringe was disconnected and gently shaken. During infusion, samples from the 3 groups were collected hourly for analysis of fat and caloric content.
  
  
  RESULTS
  The 3 groups of homogenization showed similar fat content at the beginning of the infusion. For fat, mean (SD) hourly changes of -0.03 (0.01), -0.09 (0.01), and -0.09 (0.01) g/dL were observed for the hourly agitation, baseline agitation, and ultrasound groups, respectively. The decrease was smaller for the hourly agitation group (P < .001).
  
  
  CONCLUSIONS
  When thawed HM is continuously infused, a smaller fat loss is observed when syringes are agitated hourly versus when ultrasound or a baseline homogenization is used.
authors.affiliation: Department of Neonatology, 12 de Octubre Hospital, Madrid, Spain nadiaraquelg@yahoo.es.
authors.forename: Nadia Raquel
authors.initials: NR
authors.lastname: García-Lara
authors.affiliation: Department of Neonatology, 12 de Octubre Hospital, Madrid, Spain.
authors.forename: Diana
authors.initials: D
authors.lastname: Escuder-Vieco
authors.affiliation: Department of Neonatology, 12 de Octubre Hospital, Madrid, Spain.
authors.forename: Clara
authors.initials: C
authors.lastname: Alonso Díaz
authors.affiliation: Department of Neonatology, 12 de Octubre Hospital, Madrid, Spain.
authors.forename: Sara
authors.initials: S
authors.lastname: Vázquez Román
authors.affiliation: Clinical Research Unit-IMAS12-CIBERESP, 12 de Octubre Hospital, Madrid, Spain.
authors.forename: Javier
authors.initials: J
authors.lastname: De la Cruz-Bértolo
authors.affiliation: Department of Neonatology, 12 de Octubre Hospital, Madrid, Spain.
authors.forename: Carmen Rosa
authors.initials: CR
authors.lastname: Pallás-Alonso
mesh_terms: D004750:Enteral Nutrition / Q000379:methods*; D005260:Female; D005615:Freezing; D006801:Humans; D007231:Infant, Newborn; D007260:Infusion Pumps; D008055:Lipids / Q000032:analysis*; D008895:Milk, Human / Q000737:chemistry*
chemical_list: D008055:Lipids
keywords: breast milk; breastfeeding; fat; homogenization; macronutrient; pump