To add to the apparent confusion as to whether to combine breast milk and other milks in one feeding, the HMBANA 2005 publication "Best Practice for Expressing, Storing and Handling Human Milk in Hospitals, Homes and Child Care Settings" says this on pg 26:

"Feed human milk, with or without fortifiers, separate from formula to maximise the benefits of human milk.  If the mother is not producing sufficient milk for each feeding, collect as many pumpings as necessary to make one exclusive human milk feeding and use formula at the other feedings.

"Rationale:  Quan et al found that when bovine milk based formula is mixed with human milk prior to feeding, there is a significant (41-74%) decrease in lysozyme activity.  Additionally, there is significant increase in the growth of E coli, resulting from the decrease in anti-infective properties in the milk.

"Adding human milk fortifier causes a 19% decrease in lysozyme but no corresponding effect on the anti-infective properties or increased growth of E coli."

References quoted:

Narayan I, Prakash K, Murthy NS, Gujral W.  Randomised controlled trial of effect of raw and holder pasteurised human milk and of formula supplements on incidence of neonatal infection.  Lancet 1984; 2(8412):1111-3

Quan R, Yang C, Rubinstein S, Lewiston NJ, Stevenson DK, Kerner JA, Jr.  The effect of nutritional additives on anti-effective factors in human milk.  Clin Pediar (Phila) 1994;33(6):325-8

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