Sara DiLauro1, Jennifer Russell2, Brian W McCrindle3, Christopher Tomlinson4, Sharon Unger5, Deborah L O'Connor6. 1. Department of Nutritional Sciences, University of Toronto, Medical Sciences Building, 5th Floor, Room 5253, 1 King's College Circle, Toronto, M5S 1A8, Canada; Labatt Family Heart Centre, The Hospital for Sick Children, 555 University Avenue, Toronto, M5G 1X8, Canada; Translational Medicine Program, The Hospital for Sick Children, 686 Bay Street, Toronto, M5G 0A4, Canada. 2. Labatt Family Heart Centre, The Hospital for Sick Children, 555 University Avenue, Toronto, M5G 1X8, Canada; Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, M5G 1X8, Canada. 3. Department of Nutritional Sciences, University of Toronto, Medical Sciences Building, 5th Floor, Room 5253, 1 King's College Circle, Toronto, M5S 1A8, Canada; Labatt Family Heart Centre, The Hospital for Sick Children, 555 University Avenue, Toronto, M5G 1X8, Canada; Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, M5G 1X8, Canada. 4. Department of Nutritional Sciences, University of Toronto, Medical Sciences Building, 5th Floor, Room 5253, 1 King's College Circle, Toronto, M5S 1A8, Canada; Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, M5G 1X8, Canada; Department of Neonatology, The Hospital for Sick Children, 555 University Avenue, Toronto, M5G 1X8, Canada. 5. Department of Nutritional Sciences, University of Toronto, Medical Sciences Building, 5th Floor, Room 5253, 1 King's College Circle, Toronto, M5S 1A8, Canada; Department of Neonatology, The Hospital for Sick Children, 555 University Avenue, Toronto, M5G 1X8, Canada; Rogers Hixon Ontario Human Milk Bank, Mount Sinai Hospital, 600 University Ave, Toronto, M5G 1X5, Canada; Department of Pediatrics, Mount Sinai Hospital, 600 University Avenue, Toronto, M5G 1X5, Canada. 6. Department of Nutritional Sciences, University of Toronto, Medical Sciences Building, 5th Floor, Room 5253, 1 King's College Circle, Toronto, M5S 1A8, Canada; Translational Medicine Program, The Hospital for Sick Children, 686 Bay Street, Toronto, M5G 0A4, Canada; Rogers Hixon Ontario Human Milk Bank, Mount Sinai Hospital, 600 University Ave, Toronto, M5G 1X5, Canada; Department of Pediatrics, Mount Sinai Hospital, 600 University Avenue, Toronto, M5G 1X5, Canada. Electronic address: deborah.oconnor@utoronto.ca.
Abstract
BACKGROUND & AIM: Previously we showed that modified fat breast milk (MFBM) facilitated resolution of post-surgical chylothorax in cardiac infants, but their weight-for-age and length-for-age z-scores declined over the ≥6-week treatment duration. Our aim was to evaluate the growth of infants diagnosed with post-surgical chylothorax and fed according to one of two proactive feeding protocols using MFBM or a high medium triglyceride (MCT)-containing formula (standard of care). METHODS: In this open-label trial, infants who were receiving >50% of their enteral feeds as breast milk prior to chylothorax diagnosis were randomized to receive their enteral feeds according to one of two proactive MFBM protocols: Target Fortification (n = 8), where the protein concentration of defatted breast milk was measured weekly and multi- and single-nutrient modulars were added to provide 3.5 g/kg/day of protein; or Higher Initial Concentration (n = 8), where defatted breast milk was initially fortified to an energy and nutrient level higher than that of unmodified breast milk (80kcal/100 ml; 2.2 g/100 ml protein). A third nonrandomized group of infants (n = 8) received high MCT formula (68kcal/100 ml; 2.3 g/100 ml protein). The intervention lasted for a minimum of 6-weeks after chest tube removal and continued after discharge. Weekly weight, length and head circumference (HC) measurements were completed. RESULTS: At enrolment, there was no statistically significant differences in mean (±SD) weight-for-age (-1.6 ± 0.9, n = 24), length-for-age (-1.3 ± 0.8), or HC-for-age (-0.9 ± 1.0) z-scores among groups. Changes in mean weight- (-0.3 ± 0.9, n = 23), length- (0.1 ± 0.6) and HC-for-age (0.2 ± 0.6) z-scores did not differ among groups over the treatment period. There was no difference in duration or volume of chest tube drainage across groups. CONCLUSION: Use of proactive MFBM feeding protocols both resolve chylothorax and support growth in infants following cardiothoracic surgery. TRIAL REGISTRATION: ClinicalTrials.gov (NCT02577419).
RCT Entities:
BACKGROUND & AIM: Previously we showed that modified fat breast milk (MFBM) facilitated resolution of post-surgical chylothorax in cardiac infants, but their weight-for-age and length-for-age z-scores declined over the ≥6-week treatment duration. Our aim was to evaluate the growth of infants diagnosed with post-surgical chylothorax and fed according to one of two proactive feeding protocols using MFBM or a high medium triglyceride (MCT)-containing formula (standard of care). METHODS: In this open-label trial, infants who were receiving >50% of their enteral feeds as breast milk prior to chylothorax diagnosis were randomized to receive their enteral feeds according to one of two proactive MFBM protocols: Target Fortification (n = 8), where the protein concentration of defatted breast milk was measured weekly and multi- and single-nutrient modulars were added to provide 3.5 g/kg/day of protein; or Higher Initial Concentration (n = 8), where defatted breast milk was initially fortified to an energy and nutrient level higher than that of unmodified breast milk (80kcal/100 ml; 2.2 g/100 ml protein). A third nonrandomized group of infants (n = 8) received high MCT formula (68kcal/100 ml; 2.3 g/100 ml protein). The intervention lasted for a minimum of 6-weeks after chest tube removal and continued after discharge. Weekly weight, length and head circumference (HC) measurements were completed. RESULTS: At enrolment, there was no statistically significant differences in mean (±SD) weight-for-age (-1.6 ± 0.9, n = 24), length-for-age (-1.3 ± 0.8), or HC-for-age (-0.9 ± 1.0) z-scores among groups. Changes in mean weight- (-0.3 ± 0.9, n = 23), length- (0.1 ± 0.6) and HC-for-age (0.2 ± 0.6) z-scores did not differ among groups over the treatment period. There was no difference in duration or volume of chest tube drainage across groups. CONCLUSION: Use of proactive MFBM feeding protocols both resolve chylothorax and support growth in infants following cardiothoracic surgery. TRIAL REGISTRATION: ClinicalTrials.gov (NCT02577419).