Working in a NICU, I've faced the same problem as Brenda. Because of the
nature of that environment we deal daily with babes that a bit ago would
have had no chance of survival. Everything we do there is evolving as we all
learn more. Especially in meeting all the nutritional needs and benefits.
I'd love the research/ references also. But from another angle, I also ask
my Drs. " so what does it hurt to give EBM the best chance to give all its
benefits and just give it first- let it "coat" the gut and then give the
formula?" The only benefit from mixing is its faster .....so? Even as the
climate changes within the hospital setting, it's sad how we still have to
prove or disprove various things involved with breast milk and
breastfeeding. Just because we've always done it like that or the other
hospital did that , etc. SO WHAT? Not everything we do in health care is
absolutely evidence based.. many meds and techniques are used out of basic "
guidelines".. all in the hope of improving the health and quality of life
for that patient. We use noise, light reductions, skin to skin, positioning
rolls, etc. to try and improve the outcomes by giving the most benefit to
natural support... why not breastmilk? The good news is the climate IS
changing. Breastmilk is being given and used more than it ever has before.
We just need to keep trudging through the trenches and not just proving the
research from "our" side but also asking WHY it has to be proved. When asked
to provide long term proof I remind the Drs.... overall breast milk
apparently did make a statistical difference to us as a species since we
have lasted long enough to evolve to the ability to ask questions. 
Lisa Jones RN IBCLC Tacoma, WA

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