Expressed mothers' milk (EMM) is fed to preterm (PT) infants assuming a caloric content of 20-24 cal/oz. During a 3-month period, the creamatocrit(CRCT) technique, an accurate estimate of lipid and caloric content of EMM, was used to analyze fresh EMM specimens from 12 consecutive mothers of PT infants, whose mean birthweights and gestational ages were 1029g (670-1545g) and 28.2 wks (24.4-34.0 wks). Initial CRCTs were performed when infants tolerated full enteral feedings, with the intent of fractionating and feeding hindmilk (postejection EMM), thought to provide higher calories in the form of lipid than does EMM from “full pumping” (foremilk and hindmilk). Each CRCT measure was done on an EMM specimen obtained from a “full pumping” (not hindmilk) using a hospital grade electric breast pump and double collection kit. Our preliminary data revealed that these CRCTs ranged from 8-16%, (26.4-43.5 cal/oz; 56%-70% of calories supplied as lipids), in contrast to previous reports in which CRCTs averaged 5% (20 cal/oz; 44% of calories supplied as lipids). For 7 of the mothers, CRCT measures were performed weekly; consecutive CRCTs from the same mothers remained consistently elevated, reflecting within-mother variability of ≤ 1% over a 3-4 week period. These findings suggest that the lipid content in EMM may be elevated for a subset of mothers of small PT infants who express milk for several weeks. These data underscore the importance of routine compositional analysis and individual fortification of EMM, to ensure an appropriate balance of lipid, protein, and carbohydrate for PT infant feeding.Figure

figure 1