Good Morning!  I work as an LC in a hospital setting.  Our nursery is a 
Level 2 and we care for many 34-38 weekers.  I am in the process of writing 
a policy for gavage feeding these little ones.  Often, our mother's are not 
producing as much milk as the infant needs for growth, so, sadly, we need 
to use formula in addition to mother's milk.  (Our doctors are not 
accepting of donor milk, yet.)  We try to maintain gavage and 
breastfeedings without bottles when possible.  

It seems that I was born with the knowledge that one should always gavage 
feed the expressed mother's milk before the formula; especially, not mixing 
them together.  Now that I am writing this policy, I cannot seem to find a 
reference or a study supporting this.  I have found many of the Special 
Care Baby nurses have been mixing them routinely and are reluctant to 
change (as usual).  Eventhough it makes perfect sense if one considers the 
function of IGA and some of the other protective qualities of MOM, I need 
some scientific evidence for this practice!  Does anyone remember seeing 
this anywhere, or have any ideas?  

An additional question is:  Some mothers only come in one or two times a 
day, bringing their pumped milk with them and leaving after the next 
feeding.  Is it better to divide the mother's milk up so there is some that 
can be given before each feeding, to coat the gut, or is it better to feed 
the milk as fresh as possible, resulting in some later feedings having no 
MOM?  I would appreciate any thoughts on this concern.  

Thank you, all, for any advise--I work alone and quite isolated, so Lactnet 
has been a godsend for me to follow and use.  Some days, it's like talking 
to someone with the same passion--good therapy!

Thanks, again, Elayne Clubb RN, IBCLC. 

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