Milk preparation in nicu

[AMIRA]

Dear all

can you pls share with me milk preparation and milk storage practices in your hospitals and if you have evidence based ones.

thanks.

[Stefan Johansson]

We have a national recommendation regarding handling of breast milk in neonatal care.

Most preterm infants are fed by mother's own milk. Nurses instruct mothers to start pumping after delivery.

Milk containers are frozen to -20 degr Celcius and can be kept for six months.

A frozen container is warmed in luke warm water before adding additives in form of extra protein etc.

If fresh milk is used, this is only kept in the fridge for 48-72 hours.

[Guest Dukstar]

By the way, I was wondering how milk fortifier such as Eoprotin was added to human milk.

Let's say that I want to enrich with 5% Eoprotin a pool of 50 ml freshly extracted mother's milk. That make 2,5 g to be added to the sample... How do you perform in practice with such a low amount of grammes to be added ...

[gayle omansky]

Hi Amira,

We use fresh mother's breast milk (MBM) if at all possible. We will keep plain MBM refrigerated for 3-4 days prior to use, but if we have added Human Milk Fortifier to the milk we must use it up within 24hrs. We use plastic containers for MBM storage & I know there has been discussion in the past re: glass or plastic. We use plain MBM for feedings until the babe has reached feeding volumes of 140ml/kg/day. At that point we start adding HMF if under 35wk gest., or a preterm powdered formula for added cals if over 35wks. We move up as the babe tolerates feedings from 22cal/oz to 28cals/oz. We rarely go as high as 30cal/oz. Our unit has a pediatric nutritionist who weekly calculates the daily protein/kg intake of each babe amongst other calculations. I know there is some new research supporting increasing protein intake even more. I could get you a reference when I go to work tomorrow. Is this the sort of info you were looking for? As far as other info... some places use nutrition techs to mix feedings, but at my place it is an RN responsibility. Each babe has a lidded storage box in the fridge. Each container has a sticky label with name, ID # and birthdate. When we add cals we add another label which has all the possible additives specified & the RN fills in the amounts added.

Hope this was the type of info you were looking for.

[Batkin]

Are there circumstances where 2 or more different additives/fortifiers are added to a single bottle/syringe?

[Stefan Johansson]

Are there circumstances where 2 or more different additives/fortifiers are added to a single bottle/syringe?

Yes, we almost always use two different additives, extra lipids and protein.

[gayle omansky]

Hi Batkin, Our protocol has one additive until we reach 24 calories/ 30ml. After 24 cals we use a second additive which is medium chain triglycerides. We also use an additional protein additive and occasionally a carbohydrate additive. Our recipes have been created by our pediatric nutritionist in consultation with our referral institution and the product manufacturers, most of the time we max at 28 cals/ 30ml, but occasionally we have gone to 30 & 32 cals/ 30ml. We make up the added cal feedings ahead of time (12-24 hrs.). I have also worked in a unit where the medium chain triglycerides were added at the last minute.

[babynurse3]

How do you get the MCT's? Do you use the oil or do you have something different? We use the oil when we need to add them, but we find that they stick to the plastic, so our nutritionist wants them fed via a syringe or right into a nipple. It is really wierd, but some babies take it right down.

[babynurse3]

When you are adding your additives, do you have any special equipment that you use? Do you use a hood or do you just add it at the bedside?

[Stefan Johansson]

When you are adding your additives, do you have any special equipment that you use? Do you use a hood or do you just add it at the bedside?

Each Karolinska unit have a "Milk kitchen" - a dedicated room for preparation of milk, additives etc. Looks like a kitchen too. But very clean!