Table 3. Safe Handling of Pumped HM for Preterm Infant Feeding in the NICU.

Data from Meier PP, Patel AL, Bigger HR, et al. Human milk feedings in the neonatal intensive care unit. In: Rajendram R, Preedy VR, Patel VB, eds. Diet and nutrition in critical care. New York: Springer-Verlag; 2015:807–822 and Meier PP, Rossman B, Patel AL, Johnson TJ, Engstrom JL, Hoban R, Patra K, Bigger HR. Human milk in the neonatal intensive care unit. In: A state-of-the-art view about human milk and lactation. Stuttgart: Thieme; in press.

Objective	Best Practices
A. Maximize nutritive and bioactive components	Feed freshly pumped, never frozen, HM to greatest possible extent Freshly pumped, unfortified HM can be refrigerated for up to 96 hours Do not pasteurize mothers’ own HM Implement mechanism for identifying pumped colostrum and transitional HM so it can be fed in the order it is pumped during advancement of enteral feedings Alternate colostrum and transitional HM with freshly pumped HM after 72 hours post-feed initiation if colostrum and transitional HM collections have been previously frozen Minimize number of temperature changes (e.g., serial refrigeration + warming)
B. Optimize nutrient delivery and utilization	Feed freshly pumped, never frozen, HM to greatest possible extent Use strategies to minimize the impact of exogenous additives on the delivery and utilization of HM components Feed HM by intermittent rather than continuous gavage infusion to prevent lipid entrapment in infusion tubing and resultant loss of nutritional lipid and energy Invert syringe (bevel upward) if intermittent feedings are placed on an infusion pump to ensure HM lipid is delivered to infant Flush HM remaining in infusion tubing after feeding with 1–2ml air so that infant receives as much of trapped lipid as possible
C. Minimize bacterial contaminants and bacterial growth	Feed freshly pumped, never frozen, HM to greatest possible extent Standardize protocols for collection, storage and transport of HM that are user-friendly and easily understood by NICU families Ensure all HM specimens are collected and stored in sterile receptacles Store all pumped HM in industrial NICU refrigerators and freezers that are tamper-proof and routinely monitored for appropriate temperature maintenance Do not implement a routine culturing surveillance program for pumped HM as this approach has been shown ineffective in minimizing bacteria Use waterless warming and thawing techniques to prevent HM contamination Feed previously frozen HM within 24 hours of thawing
D. Eliminate errors in HM fed to the wrong infant	Implement a HM management system that minimizes the risk of HM being fed to the wrong infant Engage parents in the importance of accurate labeling of HM receptacles and other activities (such as checking that all pumped HM is moved from one NICU room to another with the infant) per individual NICU protocol