Preface

1

Introduction

2

SECTION 1

HYGIENE

4

Hand hygiene at home

4

Hand hygiene in the hospital or child care setting

4

Alcohol rubs

5

Gloves

6

Maternal hygiene

6

Clean milk collection

6

Bacteriologic screening of milk

8

SECTION 2

EDUCATION OF MOTHERS

9

Education

9

Hand expression

10

Drip milk

10

Pump information

11

Establishing/maintaining a milk supply with a pump

12

Faltering milk supply

14

Slow weight gain & increasing weight gain

16

SECTION 3

CLEANING PUMP EQUIPMENT

17

Cleaning and maintenance of pumps

17

Sterile pump kits

17

Cleaning pump kits: both at home and in the hospital

17

SECTION 4

CONTAINERS AND RELATED ISSUES FOR MILK STORAGE

19

Milk containers for healthy babies

19

Milk containers for in-hospital use

20

Non-sterile containers

21

Lids

21

Labeling containers

21

Labeling refrigerators and freezers

22

Freezing milk

22

Adding to a container

22

Refrigerators/freezers for storage of milk:

22

At home/child care

22

In hospital

23

Transport/shipping

24

Travelling by air with mother’s milk

24

Transporting milk in check luggage

25

SECTION 5

HANDLING MILK

26

Handling fresh, frozen, or pasteurized milk

26

Thawing

28

Color of milk

29

Appropriate temperature for feeding

29

Defrosted frozen milk with a soapy odor/taste or rancid odor/taste

31

Discarding milk

32

SECTION 6

FEEDING HUMAN MILK IN THE INTENSIVE CARE NURSERY

33

Benefits of human milk for preterm infants

33

Donor milk

34

Milk donation

34

Gut priming

35

Supporting milk production

35

Steps to getting the infant to the breast

37

Late preterm infants: supporting initiation and establishment of breastfeeding

37

SECTION 7

USE OF FORTIFIERS AND EFFECTS ON STORAGE TIME

38

Adding fortifiers

38

Storage duration

39

SECTION 8

MANAGEMENT OF EQUIPMENT AND FEEDINGS IN THE INTENSIVE CARE SETTING

40

Preparation of feedings

4D

Tubing & Syringes

40

Order of use of milk

41

Loss of fat and nutrients

41

Exposure to light

42

Mixing milk and formula

42

Appendix 1

Evaluation Criteria for Evidence Cited

43

Appendix 2

Summary of Storage Duration for Human Milk

44

Overview

44

Table: Storage of Human Milk for NICU & High Risk Infants

45

Table: Storage of Human Milk that has been fortified for NICU S. High Risk Infants

46

Table: Storage of Human Milk for Term Infants

47

Table: Storage of Human Milk for Older Children

48

Appendix 3

Information for Mothers on Expressing & Storing Milk for their own Infants

49

Appendix 4

Human Milk Errors: when the wrong milk is fed to the wrong baby

50

Infectious Agents Transmitted via Breast Milk

51

Information for Health Care Providers

52

Information for Parents: When your Baby Receives Another Mother’s Milk

53

Information for Parents: When Your Milk is Given to Another Mother’s Baby

55

Checklist: Exposure of Baby to Breast Milk from a Non-birth Mother

57

Flowchart: Incident occurs

59

Appendix 5

Risk Management Issues for Storage and Dispensing of Human Milk in the Hospital

60

Appendix 6

Donor Milk Use in Hospital

61

General Guidelines for Use of Donor Milk in the NICU

61

Agreement for Use of Donor Milk

63

Hospital Tracking of Donor Milk Use

64

Log Sheets

65

Donor Milk Receiving Form

66

Donor Milk Useage Log

67

Donor Milk Recall Form

67

Appendix 7

Summary of HACCP for Handling Expressed Human Milk in the Hospital Setting

68

Appendix 8

HMBANA

69

Member Banks

69

Developing Banks

70

Advisory Council

70