Hang time for breastmilk

NICU_Nurse, BSN, RN · Sep 25, 2003

okay, so it's thursday and not monday, but i had to work ot.

the flier i found wasn't exactly what i thought it was, but it was partially relevant to this discussion (and interesting, imo), so i'll post it here for those who haven't seen this yet (don't know if everyone got this or not on their units). here it is:

powdered fortifier effects on preterm human milk's antibacterial action:

background: human milk has cellular and hormonal factors that protect infants against various virus, fungus, and bacteria. however, the nutritional content of hm is not suffecient to meet the nutritional needs of preterm infants. human milk fortifiers have been designed to meet these nutritional needs. in the united states, there are two commercially available powdered fortifiers, enfamil and similac hm fortifiers, that increase the nutrients in hm for the preterm infant. a major difference between these two fortifiers is that enfamil contains iron that may decrease hm's lactoferrin antibacterial property. (my note: fyi, enfamil contains 1.44mg iron per 4 packets, and similac contains 0.35mg iron per 4 packets).

study objectives: evaluate the effects of human milk mixed with commerciallya vailable powdered human milk fortifiers (hmf) on the bacterial inhibition against e. coli, staph aureus, gbs, and e. sakazakii compared to human milk alone.

study design: human milk was collected from mothers who delivered prematurely after the 1st week postpartum. human milk was used as a control and with each of the powedered commercial fortifiers. bacterial inhibition of human milk (hm) alone, hm+ similac hmf, and hm + enfamil hmf was tested by a filter paper method. after 36 hours of incubation, the diameter of the clear zone around the filter paper disk was measured as an indicator of the bacterial inhibition of the milk samples.

results: human milk alone and in combination with similac hmf were similar in their inhibitory activity. the diameter of the zone of inhibition of samples of hm + enfamil hmf were significantly different from hm or hm + similac hmf.

conclusion:[/b} human milk has antibacterial activity against e. coli, staph, gbs, and e. sakazakii. it was not adversely affected by similac human milk foritifier.

resource:

chan, gm. powdered fortifier effects on perterm human milk's antibacterial action. pediatr res 2003;53:421a (abstract) and in press, j. perinatol.

--end article--

so, basically, preterm human milk has antibacterial properties alone. with low-iron fortifier preparations, these properties are not disturbed. with higher iron preparations, these antibacterial properties are weakened significantly.

i thought that was interesting; sorry to get sort of off topic there.

NICU_Nurse, BSN, RN · Sep 25, 2003

Well! I just got off the phone with one of the dieticians from the Enfamil corporation! Verrrrrrrrrrrrrrry interestink. (rubbing chin thoughtfully)

First of all, I recommend that all of you speed-dial these people and have them fax over the copies of NICU-related product information, specifically that regarding hangtime for Enfamil formulas via tube feedings and HMF used in breastmilk continuous feedings. I spoke to two women there, and both were very helpful! The number is 1-800-BABY-123.

Now, don't quote me, because I have to get this thing faxed over to me when I get back to work. But...this is what I typed as she was speaking.

As some of you may know, the Lipil formulas (which, btw, are all we have now- they have completely replaced the original Enfamil at our facility) have on the label that all unused formula should be discarded after opening. The formula begins to grow bacteria that could be harmful after two hours. This is something to keep in mind if people are re-capping the bottles and saving the rest for the next feed. They said that re-capped formulas can be refridgerated immediately and must be used within 48 hours.

If the formula has been heated (ie, in a warmer or in a cup of warm water), it should be discarded in 1 hour due to bacterial growth.

If the baby has been fed from a bottle, the bottle of formula (no matter what kind it is- breast milk with or without HMF, or formula of any type) should be discarded in 1 hour due to oral bacteria mixing with the formula.

Breastmilk with HMF in it can be refridgerated for 24 hours ONLY- it must be discarded from the refridgerator after 24 hours.

Here comes the part I found most interesting. :)

If you're feeding a baby breastmilk that has HMF in it, the feed is only good for 2 hours at room temperature. The HMF does NOT extend the life of the breastmilk. (The study I put up earlier, btw, is based on Similac- remember the iron issue?)

*If* a baby is HEALTHY and has no immune system issues, self-mixed concentrated formula can hang up to eight hours (ie, in a feeding tube or quantum style pump). In this same baby, the powdered formula, when mixed, can hang for four hours. In this same, healthy baby, pre-mixed formula (the kind most of us get- already prepared) can be hung for up to four hours.

In a preterm or sick or immunocompromised NICU patient, the rules are: 2 hours hangtime FOR EVERY SINGLE TYPE OF ENFAMIL PRODUCT, including Enfamil LIPIL formulas, breastmilk with Enfamil HMF, etc.

I'm calling Similac next. :)

Mimi2RN, ASN, RN · Sep 25, 2003

Very interesting......this should change the way we do things with the premies.

Thanks!

donnuchi · Sep 25, 2003

Ah, so I have opened the proverbial "can of worms"!

SheaTabRN · Sep 25, 2003

Oh Lord.....

I'm sitting here wondering if I would ever get anything done if I was changing feeds that often!!! Wow.... that is some interesting information that is totally contrary to what we are doing as a NICU. Let us know what info you get from Similac!!

Cheers!

TIGRESS99 · Oct 7, 2003

We hang breastmilk for 2 hours, with or without HMF. We also turn the syringe up to allow fat to go in. We also wash out the tubing in between syringes to avoid accumulation of fats and/or HMF.

nfprn · Oct 8, 2003

We hang all con't feeds no matter what it is for 4 hours. We change the syringe Q4, and the whole setup Q8.

Mofe'ny · Oct 8, 2003

Our continuous feeds are also changed Q 4 hours. HMF is a charge item here though. So, Kristy, any new info from Similac?

NICU_RNwantsFL · Feb 1, 2004

Here, all feeds have max. hang time of 4 hours.

mweaverrn · Feb 2, 2004

Our feedings are either straight gavage, over 1 hr. or over 2 hrs. We do hands on care every 3 hrs. We store fresh milk 48 hrs. and frozedn 24 hrs. regardless of whether it has been mixed with HMF. This is our unit specific practices.

NICU_RNwantsFL · Feb 2, 2004

mweaverrn -

You store fresh breastmilk longer than frozen? We keep fresh breastmilk only 24 hours, then would have to freeze or toss (unless dr. wrote order that we could use for 48 hr.) We keep frozen on hand indefinitely - but once thawed, must use within 24 hrs. (again, unless dr. order for 48). We don't freeze breast milk with HMF (or any other additive) - we add it to fresh or thawed breastmilk, then use accordingly.

What are the rest of y'all out there doing?

mweaverrn · Feb 2, 2004

OK let me clarify this. We don't personally freeze any breastmilk in our unit. Once the breastmilk is thawed we only keep it 24 hrs. from the time it was taken out of the freezer. If a mother should bring in fresh breastmilk we keep it 48 hrs. from the time it was pumped. And of course we only add the HMF to breastmilk we are using. So we wouldn't be freezing any breastmilk with HMF added. We tell the parents that fresh breastmilk can be kept refrigerated for 48 hrs. and once frozen can be kept 3-6 mos. depending on the type of freezer it's kept in. Once taken out of the freezer to thaw only good for 24 hrs.