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Mixing Breast Milk with Formula

NICU   (79,790 Views 15 Comments)
by Love_2_Learn Love_2_Learn (Member) Member

Love_2_Learn has 21 years experience and specializes in Level II & III NICU, Mother-Baby Unit.

5,936 Profile Views; 223 Posts

I'm hearing something I've never heard of and need to know if there is research out there to support this issue. The issue is this: Does mixing formula and breast milk together in the same bottle or syringe change the composition of the milks and therefore should not be done?

For example a baby is to eat 20 ml each feeding. Doctors orders say, "Feed 20 ml breast milk or Premature Enfamil 20 calorie, po/og every 3 hours". You have 15 ml of breast milk left in the fridge, none in the freezer. Should you not mix the 15 ml breast milk with 5 ml formula in the same bottle or syringe for feeding because it "changes the formula composition"?

I can understand that if a baby likes the taste of breast milk better than formula then to feed them in separate bottles because mixing them could make the feeding taste icky to them, but what if you are doing only OG/NG tube feeding? I think it would be great to keep aside a drop of breast milk in an oral syringe to place on the baby's tongue with a pacifier during the tube feeding, but then why would you not mix the breast milk and formula in the syringe for tube feeding?

Am I making any sense? I mean, they are going to get mixed in the stomach at the same time anyway, right? Do stomach acids make a difference? What else could the reason be? Share your knowledge with me. This is something I've never heard of in all my 20 years of NICU nursing... I've done a little research this morning after coming home from work but was wondering if there are some new studies about this topic....

Thanks in advance!:)

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According to this website, the main hazard with mixing is that the combined amount may not be finished and breast milk would then be wasted. Probably not a concern when you're dealing with the small amounts you mentioned.

http://www.babycenter.com/404_can-i-mix-breast-milk-and-formula_8883.bc

Hope this helps.

Edited by rn/writer

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WSU_Ally_RN has 7 years experience as a BSN, RN and specializes in MICU for 4 years, now PICU for 3 years!.

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In the hospital I work at, we make fortified BM all the time by adding similac with iron concentrate to it... I wouldn't see why combining the two would hurt...

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MommyandRN has 12 years experience and specializes in ICU, OR.

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I don't work in the NICU, but I have kids. I have mixed breastmilk and formula many times. A lot of people do. At home and at day cares.

The thing you have to take in to consideration is the temperature. You shouldn't thaw the breastmilk, warm it, and then cool it again. Stick with the same temp for both, or start out with cold for both and then warm them together.

A great website for breastfeeding info is kellymom.com - tons of info there.

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Love_2_Learn has 21 years experience and specializes in Level II & III NICU, Mother-Baby Unit.

223 Posts; 5,936 Profile Views

Thank you all for your replies. I agree with everything you all have said. I just can't find any information showing how the chemistry of the breast and formula milks actually change for the worse when blended together. I honestly don't think there is any evidence proving this but am hoping someone will be able to enlighten me on this. Thanks again!

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NicuGal has 30 years experience as a MSN, RN and specializes in NICU, PICU, PACU.

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We have a very well known nutritionist that works with us and she has us mixing EBM with fortifiers and formula all the time...it if wasn't right, we wouldn't be doing it. You do it to boost the calories and minerals and sometimes the proteins.

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Elvish is a BSN, DNP, RN, NP and specializes in Community, OB, Nursery.

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We've done it many times with our more puny kids who need Mom's breastmilk but also need extra calories. In our nursery (well-baby plus a little) we usually have a order for a specific amount. Sometimes it's just powdered formula we mix in with the breastmilk; other times it's the liquid form, it just depends on the baby and the peds.

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MommyandRN has 12 years experience and specializes in ICU, OR.

342 Posts; 10,636 Profile Views

Thank you all for your replies. I agree with everything you all have said. I just can't find any information showing how the chemistry of the breast and formula milks actually change for the worse when blended together. I honestly don't think there is any evidence proving this but am hoping someone will be able to enlighten me on this. Thanks again!

No, it does not change the composition of either milk. Does not make a difference. As long as the temperatures are not compromised it's fine. If you'd like, you can give the breastmilk first separately, then formula second.

Here is the section on kellymom for pumping and storage of breastmilk - http://www.kellymom.com/bf/pumping/index.html

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NicuGal has 30 years experience as a MSN, RN and specializes in NICU, PICU, PACU.

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In the above link, it states that you should put in warm water...I thought cool water was the way to thaw the milk as it doesn't change the proteins/antibodies...some moms may put it in hot water and that is a no no. Once thawed you can warm it up, but for thawing it should be a cool water thaw. It sounds silly, but it works, and some of the sited articles are a lot older, not current EBP. Just an FYI.

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BabyLady is a BSN, RN and specializes in NICU, Post-partum.

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This is what our policy is...and it is a very strict policy that we religiously follow:

1. We can mix formula and breast milk together, but only if you get the amount exact and feed it through a syringe and flush the tubing to be sure you get out all the milk (we just use 1 ml of air).

2. Nipple feeds....never, ever mix formula and breast milk. It is not the taste, but not wasting breast milk if the infant doesn't take the whole feeding.

We used to have a huge issue with nurses wasting breast milk but they finally cracked down on the policy.

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TiffyRN has 26 years experience as a ADN, BSN, PhD and specializes in NICU.

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2. Nipple feeds....never, ever mix formula and breast milk. It is not the taste, but not wasting breast milk if the infant doesn't take the whole feeding.

The unit where I work does not have any policy regarding mixing formula & EBM. Myself I usually put the breast milk in first and let the infant finish it first (or not) and then add formula to the same bottle to try to rinse any remaining EBM off the sides of the bottle. I may mix EBM & formula in the same bottle initially if I know the infant will get everything in that bottle whether by bottle or by gavaging remainder (i.e. I will not overfill the bottle any).

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BabyLady is a BSN, RN and specializes in NICU, Post-partum.

2,300 Posts; 14,766 Profile Views

The unit where I work does not have any policy regarding mixing formula & EBM. Myself I usually put the breast milk in first and let the infant finish it first (or not) and then add formula to the same bottle to try to rinse any remaining EBM off the sides of the bottle. I may mix EBM & formula in the same bottle initially if I know the infant will get everything in that bottle whether by bottle or by gavaging remainder (i.e. I will not overfill the bottle any).

...we are in agreement...this is exactly how I feed as well. We only mix it in the syringe because we can measure that exactly.

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