Mixing Breast Milk with Formula

Specialties NICU

Published

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!:)

Specializes in NICU level III.

We always mix our milk like that, I say no problemo. Plus, thats how we would fortify our milk is by adding formula to it.

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Specializes in NICU.

I mix them together all the time, and have never heard of it changing the composition of the breast milk itself. I only mix it for nipple feedings if I know the entire volume will be consumed in one way or another, but that's just so I don't waste it, not because of any kind of chemical change.

It all mixes together in the tummy anyways...

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Breastmilk contains antibodies. When breastmilk is mixed with formula, the formula compromises the antibodies, especially the colostrum antibodies which when fed alone coats the gut wall with sIGA to protect the infant's gut from absorbing pathogens/allergens, and can help avoid sensitisizing the infant to the cow's milk protein in the formula.

Ideally, when feeding both breastmilk and formula feeds, breastmilk should be given first and allowed to be digested somewhat before the formula is given fed. Yes, they will mix in the infant's gut, but the antibodies and ingredients that are specifc to breastmilk are used more effectively when feeds are provided separately.

When responsible for several babies, this can be nearly impossible to do, but if can be done it should.

Human Milk in the NICU: Practice to Policy by Dr. Lois Arnold-is an excellent resource. Many NICUs have implemented postive breastmilk feeding policies based on the research and evidence shared here. http://www.amazon.com/Human-Milk-NICU-Policy-Practice/dp/0763761338

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