Development of home-based methods to defat human milk for infants with chylothorax: An experimental study

Background

Chylothorax is a postoperative complication for infants with congenital heart defects; with high nutrition risk. Defatted human milk is recommended; however, refrigerated centrifugation to process milk poses accessibility barriers for many hospitals and families at home. Creation of a simplified home-based defatted milk protocol allows infants with chylothorax to be provided the immunological benefits of human milk postoperatively.

Methods

Milk from 20 mothers was tested to compare refrigerated centrifugation as the standard defatting technique against gravity-based methods: syringe tip-down and gravy separator. Two timeframes, 24 h and 48 h, were tested to determine if additional time had a significant impact on fat reduction. The MIRIS human milk analyzer provided results for fat, true protein, carbohydrate, and energy content. One-way analysis of variance was used to determine a significant difference on fat content among methods.

Results

All methods had a significant reduction in fat content, with centrifugation having the largest mean decline from 3.4 to 0.5 g/100 ml (P < 0.0001). The second most effective method to defat milk was 48-h gravy separator with a mean decline to 0.7 g/100 ml (P < 0.0001). Postpartum age of milk impacted the degree of fat removal in all methods. True protein content remained the same as baseline in all methods.

Conclusion

A simplified home-based gravity separation method over 48 h reduced human milk fat by 80%. This is the first protocol to defat human milk without use of the more resource-intensive centrifugation method, that shows significant fat reduction with easy-to-use and accessible equipment for management of infants with chylothorax.