We have been having mothers number their bottles of milk for the first 30 pumpings and we use them in order for the first five days after feedings are started.   After that, we have mothers fractionate their milk into foremilk (first 1/3 of the pumping) and hindmilk (last 2/3 of the pumping) and give  fresh, never-frozen hindmilk for approximately 2 weeks, or until weight gain is optimal.   This is not my idea, it is Dr. Paula Meier's from Rush-Presbyterian St. Luke's in Chicago.  

Since we have been doing this, we have had less trouble with high residuals, and terrific weight gain.  Paula says that they are able to approximate intrauterine growth levels using this method, and I can believe it.  

The mothers are responsible for the "quality control" of their milk, and after we explain methods of extraction, storage, the properties and dynamic qualities of their breast milk, THEY decide which milk should be given depending on the baby's weight gain, condition, etc.   If the baby has to go NPO, mom knows to go back to the leftover colostrum to prepare the baby's gut again with what remains of the first 30 pumpings. Nurses don't have the time or inclination to hunt through the freezer or fridge for the correct milk - but the mothers are fanatic about getting it right.

Oh, am I ever glad I went to that conference in Boston!  Thanks, Paula.
Deanne, R.N.  IBCLC
NICU

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