Evaluation of fat separation and removal methods to prepare low-fat breast milk for fat-intolerant neonates with chylothorax

Background: The purpose of this study was to compare 2 methods (syringe and spoon methods) of removing the fat from the low-fat milk portion and compare 3 methods (refrigerated centrifuge, nonrefrigerated centrifuge, and refrigeration method) of separating breast milk into the fat and low-fat milk components.

Methods: Human milk was divided into 24 aliquots using the 3 separating methods, and 2 methods (syringe, spoon) were compared to extract the low-fat milk. Thirty-one human milk samples were separated into fatty and low-fat milk layers using 3 methods: 24-hour refrigerator storage (2°C), centrifuged at 3000 rpm for 15 minutes at room temperature, and spun in the refrigerated-centrifuge at 3000 rpm for 15 minutes at 2°C. After 24 hours of refrigeration, a syringe was used to remove the low-fat milk. Triglycerides were analyzed before and after separation and removal methods.

Results: For fat removal, the syringe method (1.2 g/dl, 95% confidence interval [CI], 1.1-1.4, fat content) left 34% less residual fat compared to the spoon method (1.9 g/dl, 95% CI, 1.5-2.3); this difference did not reach statistical significance (P = .065). For fat separation, the centrifuge methods (mean: 1.0 g/dl, 95% CI, 0.8-1.1) left significantly less residual fat than the refrigerator method (3.4 g/dl, 95% CI, 3.0-3.7; P < .0001).

Conclusion: Using the syringe vs a spoon at removing the milk from the fat, although not statistically significant, was likely of clinical importance. A centrifuge was more effective at separating the fat in human milk.