Handling, Storage, and Preparation of Infant Feedings

By: Caroline Steele, MS, RD, IBCLC, FAND

The importance of proper handling of infant feedings within the healthcare setting is well-documented.1-13 Premature and hospitalized infants often have complex nutritional needs necessitating individualized feeding regimens that require the fortification of human milk or preparation of formula to modify the nutrient density.1,5,6,13,14 Primary concerns with the preparation, handling and administration of feedings include preparation errors, contamination, and misadministration (providing the wrong human milk or wrong formula to a patient)—all of which pose safety concerns and could result in serious adverse effects.1 Contamination of infant feedings may occur at any step of the process if aseptic technique is not diligently followed. Case reports of sepsis linked to improperly sanitized breast pump parts have been documented in the literature.15 Centralized formula preparation has been shown to decrease the presence of any microbial growth in facility-prepared powdered formulas from 43.7% to 4%.13

Please read the full article: INFANT FEEDINGS: THE FORGOTTEN PATIENT SAFETY RISK by Caroline Steele, MS, RD, IBCLC, FAND, to gain a clearer understanding of the critical aspects of handling infant feedings in hospital settings. This article outlines three primary concerns: ensuring safety through contamination prevention, maintaining nutritional quality during storage and handling and promoting accountability through proper labeling and documentation. To address these concerns, the article emphasizes the importance of evidence-based practices, many of which are outlined in Infant and Pediatric Feedings, Third Edition: Guidelines for Preparation of Human Milk and Formula in Health Care Facilities. This resource provides detailed recommendations on preparation, storage, and administration protocols.

For further education on this topic or a copy of Infant and Pediatric Feedings, Third Edition: Guidelines for Preparation of Human Milk and Formula in Health Care Facilities reach out to your Mead Johnson Nutrition representative.

READ THE ARTICLE - INFANT FEEDINGS: THE FORGOTTEN PATIENT SAFETY RISK

References

  1. Steele C, Collins EA, eds. Infant and Pediatric Feedings: Guidelines for Preparation of Human Milk and Formula in Health Care Facilities. 3rd ed. Chicago, IL: Academy of Nutrition and Dietetics; 2019.
  2. Steele C. Best practices for handling and administration of expressed human milk and donor human milk for hospitalized preterm infants. Frontiers in Nutrition. 2018;5:76. doi 10.3389/ fnut.2018.00076.
  3. Moro GE et al. Human milk in feeding premature infants: From tradition to bioengineering. Proceedings of a consensus development conference—EXPO 2015. J Ped Gastroenterol Nutr. 2015;61(1):S1-S19.
  4. Oza-Frank R et al. A quality improvement project to decrease human milk errors in the NICU. Pediatrics. 2017;139(2):e2-e7. DOI:10.1542/peds.2015-4451.
  5. Steele C et al. Breast milk bar code scanning results in time savings and staff efficiency. J Acad Nutr Diet. 2015;115(1):23-26.
  6. Steele C, Bixby C. Centralized breastmilk handling and bar code scanning improve safety and reduce breastmilk administration errors. Breastfeeding Med. 2014;9(9):426-429.
  7. Barbas KH. Mother’s milk technicians: A new standard of care. J Hum Lact. 2013;29(3):323-327.
  8. Perkey K. Delivering results: Opening an infant nutrition center. Future Dimensions in Clinical Nutrition Practice. 2016;8-12.
  9. National Association of Neonatal Nurses. The use of human milk and breastfeeding in the neonatal intensive care unit. Position statement #3065. April 2015. Accessed November 17, 2023. https://nann.org/ position-statements/
  10. The Facilities Guidelines Institute. Guidelines for Design and Construction of Hospital and Health Care Facilities. Washington, DC: American Institute of Architects; 2014:91-92. Standard A2.1-7.2.3.2(3) and Standard 2.1-7.2.3.3(5).
  11. Boullata JI, Carrera AL, Harvey L et al. ASPEN safe practices for enteral nutrition therapy. JPEN J Parenter Enteral Nutr. 2017;41:15-103.
  12. Jones F. Best Practice for Expressing, Storing and Handling Human Milk in Hospitals, Homes, and Child Care Settings. 4th edition. Fort Worth, TX: Human Milk Banking Association of North America, Inc; 2019.
  13. Steele C, Short R. Centralized infant formula preparation room in the neonatal intensive care unit reduces incidence of microbial contamination. J Am Diet Assoc. 2008;108:1700-1703.
  14. Drenckpohl M, Bowers L, Cooper H. Use of the six sigma methodology to reduce incidence of breast milk administration errors in the NICU. Neonatal Network. 2007;26(3):161-166.
  15. Smith SL, Serke L. Case report of sepsis in neonates fed expressed mother’s milk. JOGNN. 2016;45:699-705.
  16. Wolford SR, Smith C, Harrison ML. A retrospective two year study of breast milk error prevention in the neonatal intensive care unit. Neonatal Intensive Care. 2013;26(2):41-42.
  17. Steele C, Alessi S. Use of Dedicated Technicians and Bar Code Scanning Technology for Fortified Human Milk Feeding Preparation in a Neonatal Intensive Care Unit Reduces Risk of Preventable Adverse Events. J Acad Nutr Diet. Published online December 21, 2023. doi:10.1016/j.jand.2023.12.007.
  18. Stark AR, Pursley DWM, Papile LA et al. Standards for Levels of Neonatal Care: II, III, and IV. 2023;151(6):e2023061957.
  19. Steele C. Safe Handling of Human Milk Within the Hospital Setting. Neonatal Intensive Care. 2020;33(3):11-14.
  20. Fernandez-Pastor S, Castello DS, Lopez-Mendoza MC. Stability of the antimicrobial capacity of human milk against Cronobacter sakazakii during handling. J Hum Lact. 2020;1-9. DOI: 10. 1177/ 0890 3344 20932574.
  21. Human Milk Banking Association of North America. Milk Handling for COVID-19 Positive or Suspected Mothers in the Hospital Setting. April 14, 2020. Accessed November 17, 2023. https://www.hmbana. org/file_download/inline/a593dd72-be78-471e-ae5e- 6490309108fd.
  22. Malone A, Nieman Carney L, Long Carrera A, Mays A, eds. ASPEN Enteral Nutrition Handbook. Silver Spring, MD: American Society for Parenteral and Enteral Nutrition; 2019.
  23. Steele C, Ehwerhemuepha L, Collins E. 24-hour versus 12-hour storage recommendations for previously frozen (thawed) fortified human milk. J Acad Nutr Diet. 2020;120(8). In press.

ABOUT THE AUTHOR

Caroline Steele, MS, RD, IBCLC, FAND

Caroline Steele, MS, RD, IBCLC, FAND Consultant, Timeless Medical Systems; Former Director, Clinical Nutrition & Lactation Services | Children’s Hospital of Orange County, Orange, CA

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The material presented in this blog represents the opinion of the author(s) and not necessarily the views of Synova Associates. Synova Associates does not endorse any specific products or organizations but strives to connect its industry partners with leaders interested in product/educational innovation.

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