I am responding to my own post: I had the priviledge of getting to ask Dr. 
Paula Meier my question - she was so gracious to call me on a Sunday 
morning... her advice: 1. if possible - use small, more frequent bolus feeds - 
like q2 hours instead of q 3. small occasional residuals without other symptom 
do not require continuous feeds. 2. If continuous feeds must be given - place 
the syringe of EBM outside of the isolet, use the shortest tubing possible and 
feed with the tip elevated to deliver the cream as it "floats to the top" In a 
neonate who is not high risk for NEC and has no symptoms other that 
residuals - ok at room temp for 4 hours 3. If continuous feed must be inside 
the isolet - so that the milk is warmed to 95 - 98 degrees - 1 to 2 hours is the 
most a single syringe should be used. If any of Dr. Meier's team is reading, and 
I have this incorrect - please chime in! Also - I did find mention that is 
powdered ( which = unsterile) HMF is added, the serving is only good at room 
temp 1 to 2 hours also. This info seems to still be inline with the posting from 
8 to 10 years ago. Thanks, Paula Hiett RN, IBCLC Longview, TExas

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