A question for you who work in NICU's as RNs/LC's.  

When you or your staff are administering a bolus feeding of fortified breast milk (powdered), and are using a syringe pump, how do you position the tip of the syringe?  I have been encouraging my staff to point the tip of the syringe upward with non-fortified breast milk to make sure that all the fat is given to the baby vs sticking to the sides of the tubing.  But there has been some confusion on how to position the tip when using fortifier.  I read somewhere that fortified milk should have the tip pointed down, to prevent a large solute load at the end of the feeding, but that goes against having the breast milk fat then rise to the end of the feeding.  We are currently updating our policy, and I have several articles on research about certain syringes for feedings, but nothing really says what the best practice is for syringe positioning.  I have the CPQCC toolkit with a picture of fortified breastmilk in a syringe at a 45 degree angle, but that is about it.  Any help here would be greatly appreciated!!! Thanks!!!!
Brenda Enfield RN IBCLC
Mercy Medical Center 
Cedar Rapids, IA

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