Best Practices for Handling and Administration of Expressed Human Milk and Donor Human Milk for Hospitalized Preterm Infants

Abstract

The importance of human milk for the preterm infant is well established (1–3). However, the feeding of human milk to preterm infants is typically much more complicated than the mere act of breastfeeding (3, 4). The limited oral feeding skills of many preterm infants often results in human milk being administered via an enteral feeding tube (4). In addition, fortification is commonly required to promote optimal growth and development—particularly in the smallest of preterm infants (2, 4, 5). Consequently, a mother's own milk must be pumped, labeled, transported to the hospital, stored, tracked for appropriate expiration dates and times, thawed (if previously frozen), fortified, and administered to the infant with care taken at each step of the process to avoid microbial contamination, misadministration (the wrong milk for the wrong patient), fortification errors, and waste (1–5). Furthermore, the use of pasteurized donor human milk (DHM) for preterm infants when a mother's own milk is not available has been endorsed by many organizations (1). Therefore, appropriate procurement, storage, thawing (if received frozen), fortification, labeling, and administration must occur with the same considerations of preventing contamination and fortification errors while ensuring the correctly prepared final product reaches the correct patient (1). Many professional organizations have published best practices to provide hospitals with guidelines for the safe and accurate handling and preparation of expressed human milk (EHM) and DHM feedings for preterm infants (1–5). These best practices emphasize the importance of preparation location, trained staff, proper identification of human milk to prevent misadministration, and strategies to prevent fortification errors (1–6). The purpose of this mini-review article is to summarize current published best practices for the handling of human milk for preterm infants within the hospital setting (1–6). Emphasis will focus on the use of aseptic technique with proper sanitation and holding times/temperatures to limit microbial growth; use of technology to prevent misadministration of human milk and fortification errors as well as for tracking of expiration dates/times and lot numbers; and workflow strategies to promote safety while improving efficiencies (1–7).

Expressed Breast Milk Contamination in Neonatal Intensive Care Unit

“…In our study, improper hand washing was associated with EBM contamination. This is consistent with the conclusions of Steele, 23 who noted that hand washing with aseptic techniques is valuable in preservation of bacterial growth to acceptable levels.…”

“…Actually, many studies have indicated that fresh milk should be cooled before adding to cold milk in the fridge and that stored milk should be rotated using first-in-first-out (FIFO) principles with the oldest milk being used first. 23 …”

Organization of breastfeeding in neonatal intensive care units: discussion issues

“…Некоторые ОРИТН предпочитают пастеризовать собственное молоко матери, чтобы снизить инфекционные риски, связанные с кормлением недоношенных младенцев с ОНМТ и ЭНМТ, до безопасного уровня [40]. В большинстве ОРИТН молоко матери не пастеризуется [30,41]: его либо сразу выдают недоношенному ребенку [30,40,41], либо хранят замороженным [30,40,41], а затем размораживают, прежде чем выдать для кормления. Процесс обработки (замораживания-размораживания) осуществляется обученным персоналом в специально отведенных помещениях [41][42][43].…”

Human milk triggers coagulation via tissue factor–exposing extracellular vesicles

“…The American Academy of Pediatrics recommends exclusive breastfeeding for 6 months followed by continued breastfeeding as complementary foods are introduced for $1 year 13 because of the firmly established beneficial effects of breastfeeding. [14][15][16][17][18][19] We speculated that the ability of human milk to promote coagulation may contribute to these beneficial effects by, for example, triggering coagulation upon gastrointestinal vascular damage. If so, the coagulant activity of TF in human milk should be able to survive the digestive conditions encountered in an infant's gastrointestinal system.…”