Iowa Neonatology Handbook: Feeding

Guidelines for Use of Human Milk in the Nursery

1. Expressed human milk is to be fed only to the infant whose mother provided the milk.
   
2. Expressed milk is precious to the mother and the baby and should be treated as a valuable commodity. It should be discarded only for a good reason.
   
3. Containers for storage of expressed milk should be small in size (4 oz. or less). If milk is to be frozen it should be stored in airtight containers (plastic or glass containers, or disposable baby bottle bags) with as little head space as possible.
   
4. Milk that will be fed within 48 hours of expression should not be frozen but be kept refrigerated at all times, including while being transported to the hospital. It is preferable to collect such milk in plastic containers. Sterile urine containers are acceptable.
   
5. Milk that will be stored for 48 hours or more should be frozen immediately after expression and transported to the hospital in the frozen state. Transport (on ice or in a cooler) should occur at least once a week, preferably more often. Milk should be frozen in portions approximately equal to the amount needed for one or two feedings.
   
6. Once thawed, milk should not be kept at room temperature for more than 4 hours. If kept refrigerated, it may be kept for up to 24 hours.
   
7. Instructions given to the mother should be specific and complete, with emphasis on cleanliness. Washing of hands with soap and water and of the breasts with water alone should be stressed. Mothers should be instructed to empty breasts as completely as possible because incomplete emptying produces milk with low caloric content (low fat). Rules pertaining to ingestion of drugs by the mother are listed in "The Effect of Drugs Taken by the Nursing Mother on Her Infant" (p. 102). The mother should notify her own and the baby's physician of any symptoms of mastitis, and milk from an infected breast should not be fed.
   
8. Milk may be expressed by hand, manual pump or electric pump. The most effective and least traumatic pumps are the Medela and Egnell electric breast pumps. Electric breast pumps are available for rent from drugstores and medical supply businesses across Iowa. Rental sources in Iowa City include Pearson's Drugs, Towncrest Drugs, Miller Medical Supply and Hawkeye Medical Supply. University Hospital has a lending service available for indigent and Medicaid patients. Some insurance companies will pay for the rental of an electric breast pump with a prescription for breast milk. The collection container for the breast pumps needs to be washed in hot soapy water and rinsed in hot water between use. The Davol hand pump (looks like a bicycle horn) should not be used for expression of milk that will be stored long term because of the reported high contamination which occurs due to the difficulty in cleaning the pump.

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