When I worked in NICU we mixed up a sufficient quantity (i.e., a shift's
worth) of fortified EBM and drew up each feeding into an appropriately
labelled syringe with cap. We then stored the pre-filled syringes in a
box with baby's hospital label in the fridge.

Each syringe had baby's hospital label with the following information
added by the RN:
- mixture (i.e., EBM with 4/100 HMF), 
- expiration time/date (= the time/date that the EBM expired or 24 hours
since mixing the EBM/HMF, whichever came 1st), and
- 2 RN signatures (the one that mixed or drew up the milk and the person
that double-checked).

The label would also include information re: added electrolytes (i.e.,
EBM with HMF 2/100 + NaCl 3/100) and/or further mixture of fortified
milks with concentrates (i.e., 80 ml EBM with HMF 4/100: 20 ml XXX
concentrate with KCl 2/100). If there was leftover milk in the mixing
bottle it would then be re-capped and the same type of label would be
placed on the bottle.

Of note, double checks were required any time that EBM was drawn up,
mixed, and/or administered to be sure that the right baby was getting
the right milk and to ensure that it was not expired.

Dru Antoniuk
Recovering NICU nurse and LC wannabe


Date:    Tue, 29 Aug 2006 09:14:02 -0400
From:    "=?windows-1252?Q?Pam_Hirsch,_RN,_BSN,_IBCLC?="
         <[log in to unmask]>
Subject: Fortified Human Milk

What are others doing in terms of the length of time fortified human
milk=

=20
can be stored?  We are revising policies in preparation for our
nursery=20=


redesignation later this year.  The question arose - must any
remaining=20=


fortified milk be discarded after a feeding or can it be stored for a=20
length of time?  We normally use one packet of fortifier per 25 ml of
EBM=

.=20=20
One of our babies (32 weeks) is currently ordered to get 38
ml/fdg.=20=20=


Someone in the nursery has said that the remaining 12 ml of fortified
EBM=

=20
must be discarded each feeding.  This poor mom is struggling for
every=20=


drop - throwing away any of her milk is completely unacceptable!  The
nur=

se=20
is fortifying 50 ml with 2 packets of fortifier, feeding the baby the=20
required 38 ml and discarding the rest.  There are 2 schools of
thought=20=


raging right now.  If EBM is viewed as a medicine, hospital policy
states=

=20
that any medication mixed at the bedside is to have any remainder=20
discarded, not saved for the next dose.  The manufacturer's directions
fo=

r=20
use state that fortified milk must be discarded after 4 hours at room=20
temperature if used for tube feeding; for bottle feeding, it must be
used=

=20
immediately and cannot be used if unrefrigerated for more than 2 hours,
a=

nd=20
any remaining after a feeding, must be discarded after 1 hour.
Unused,=20=


freshly prepared milk can be regrigerated up to 24 hours.
Our nurses, for convenience, would like to make up at least a shift's
wor=

th=20
of feedings, which would be refrigerated between feedings.
One of our sister hospitals' policy states that the fortified EBM cqn
be=20=


stored refrigerated for up to 24 hours.
Any thoughts would be appreciated.

Pam Hirsch, BSN,RN,IBCLC
Clinical Lead, Lactation Services
Advocate Good Shepherd Hospital
Barrington, IL   USA

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