When you talk about mixing formula or fortifier with human milk, you must 
consider at least 3 aspects: 
1. does it affect the anti-infective potential of the milk (YES)
2. does it affect the nutritional quality of the milk (ie-absorption of some 
nutrients - probably yes)
3. does it change the long term microbial environment or development of the 
gut (probably yes, at least in a small way).

Research tells us that bacteria grow faster in milk that has formula or 
fortifier in it (a form of formula).  Best practice is to use fortified human milk 
within 24 hrs of fortification.  I don't believe it would make much difference 
for a healthy term infant, mixed for that feed only.  

The study of whether to alternate human milk with formula or to mix it to 
stretch the human milk has not been done for premies or full-term infants.  You 
are balancing the shock to the gut of alternating pizza with ice cream, vs. 
mixing the two.  

Nancy
Nancy E. Wight MD, IBCLC, FABM, FAAP
Neonatologist, Sharp Mary Birch Hospital for Women and Children's Hospital
Medical Director, Sharp HealthCare Lactation Services
San Diego, CA
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