What Happens if You Feed a Baby Cold Breast Milk
Warming of Baby Feedings
Sandy Beauman, MSN, RNC-NIC
The practice of warming breast milk for feedings has long been a standard in the NICU. In no small-scale part, this is related to the fact that much of the expressed breast milk has been previously frozen, requiring at least thawing.
1 of the primeval publications concerning warming of babe feedings looked at infant'south acceptance of cool or common cold feedings.1 Nigh infants (67%) accepted cold feedings and no difference in growth patterns was found betwixt the groups fed cold, cool or warm milk. These infants were likely bigger, healthier infants than what we usually run into in the NICU today. In spite of the finding that infants "accepted" the milk, the do of warming milk for feedings post-obit freezing or refrigeration has been a long-standing exercise for both in-hospital and home feeding. There are several theoretical reasons to warm the milk prior to feeding. In the very depression birth weight infant, feeding of common cold milk may pb to changes in body temperature, although this has never been well-researched. Studies have attempted to testify furnishings of feeding temperature variations and effect on metabolic rate, residuals, effect on body temperature and growth patterns. Gonzales did testify an increase in residuals related to common cold feedings only this has not been replicated since and was a fairly modest sample size.2 Many other practices take changed too since that fourth dimension. So, the benefit of warming feedings and to what ideal temperature is still without good evidence. There is, however, no evidence that this is harmful. So, the accepted practice is to warm to some as nonetheless, undefined temperature. The Human being Milk Banking Association advocated warming feeds to body temperature for premature infants, especially those at adventure for necrotizing enterocolitis.3 For term infants, feedings may be given at torso temperature, room temperature or straight from the fridge. In attempts to make up one's mind at what temperature feeds are actually delivered, several studies accept been undertaken (Dumm et al, 2013, Lawlor-Klean, Lefaivor, Weisbrock, 2013). Dumm et al demonstrated a range of milk temperature from 21.8°C to 36.ii°C.iv Lawlor-Klean, Lefaiver, Weisbrock demonstrated a range of milk temperature from 22°C to 46.4°C.5 Over-warming may be as detrimental equally under warming. Over warming may lead to deterioration of some benefit from homo milk and/or furnishings on infant temperature. Under warming may pb to effects on digestion and/or trunk temperature of the infant. Is information technology possible that milk warmed to a higher temperature should not exist left as long in a continuous feed, due to concerns about bacterial growth?
Warming may occur in a diversity of methods. Clear recommendations have been adopted regarding avoidance of microwave warming.iii Past recommendations have included a preference for warming under "running water". This is non usually practical in the real world, though. The length of time required to thaw or warm a feeding to an adequate temperature is an unrealistic time for the nurse to spend at the sink property a canteen nether running h2o! Thawing milk may also occur in a diversity of means. Thawing at room temperature, in the refrigerator or in warm water are all used. If milk is thawed in warm water, information technology oftentimes reaches room temperature or warmer earlier taken from the water bath. In one case the milk has been warmed to room temperature or across, it should not be returned to the refrigerator or used for more than a few hours, usually a maximum of iv hours.6 If thawed milk is not going to be used within this four hour window, it should be thawed only not warmed. Thawing in the refrigerator or with a controlled mechanism such as is now available on the marketplace should be done to avoid warming. All of these available methods crave time to thaw. Therefore, feeding our infants requires advance planning for the day or the shift, including the side by side shift!
Back to warming of feedings…. The usual is a warm water bathroom or one of the mechanical methods now available. Concerns about the warm water bathroom besides an unreliable end temperature includes possible contagion of the feeding. The issue of contamination is worth discussion. Tap water oftentimes contains an "acceptable" level of bacteria that in the normal, salubrious population is not of business organisation. Even so, contamination of a feeding to be given to a high risk neonate could certainly cause a problem. Tap h2o often contains an "acceptable" level of pseudomonas and other bacteria we recognize every bit lethal in the NICU. Even a small amount of these bacteria can be life-threatening to our high-risk infants. In some recent functioning improvement work done in California to subtract blood stream infections, it was establish that 1 suspected cause of blood stream infection in at least fifteen% of cases not related to central lines was idea to be related to bacterial translocation from the gut, even in the absence of diagnosed necrotizing enterocolitis (unpublished data). Therefore, careful management of feedings is a must in this vulnerable population. In addition, if the temperature of the milk is indeed important in preventing feeding intolerance and necrotizing enterocolitis and peradventure enhancing growth, what consequence does the extended hang time of a pre-warmed continuous feed or feed over fourth dimension take on the ultimate temperature of the milk when it reaches the infant? If milk is infusing over xxx minutes to 4 hours with tubing extending from the pump to the feeding tube both inside and outside the incubator, temperature will modify over this time period, more than or less, depending on room temperature, length of infusion fourth dimension and incubator temperature.
Equally with many other neonatal problems, milk warming is a practice that cries out for additional enquiry. Several questions that need to be answered include:
What is the ideal milk feeding temperature?
Does milk temperature accept an effect on growth and if so, for whom?
Does milk temperature have an effect on feeding tolerance and if so, for whom?
Does milk temperature have an consequence on overall body temperature? One report found no affair what the milk temperature was, body temperature increased. This is likely related to the increase in metabolic rate following feeding. Is this besides truthful in premature infants and does it extend to very premature infants? Likely, the pocket-sized feedings we give to the very premature baby does not cause this increase in metabolic rate and therefore, trunk temperature.
Nosotros often retrieve of feeding babies as a simple, most mindless task in the NICU. As we observe out more and more than most their nutritional needs and training for feeding, we know this, as much as the delicacy of gas commutation during lung disease, requires finesse and attention. The proper diet at the proper fourth dimension is critical for tiny babies whose brains are requiring the bulk of the nutrition.
References:
one. Gibson JP. Reaction of 150 infants to cold formulas. J Pediatr. 1958; 52: 404–406
two. Gonzales, I, DurveaEJ, Vasquez E, Garahty N Effect of enteral feeding temperature on feeding tolerance in preterm infants. Neonatal Network. 1995;14(3):39-43.
three. The Human Milk Banking Clan of North America, Inc. (2011). Best Do for Expressing, Storing and Handling Human being Milk in Hospitals, Homes and Child Care Settings. HMBANA: West Hartford, CT.
iv. Dumm M, Hamms 1000, Sutton J, Ryan-Wenger North. NICU breast milk warming practices and the physiological furnishings of breast milk feeding temperatures on preterm infants. Advances in Neonatal Care. 2013;13(4):279-287.
5. Lawlor-Klean P, Lefaiver CA, Wiesbrock J. Nurses' perception of milk temperature at delivery compared to actual do in the neonatal intensive care unit. Advances in Neonatal Care. 2013;xiii(5):E1-E10.
6. Robbins S, Meyers R. Pediatric Diet Practice Group. (2011). Infant feedings: Guidelines for training of human milk and formula in health care facilities 2nd ed. American Dietetic Association.
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Nigh the Writer
Sandy Sundquist Beauman has over thirty years of experience in neonatal nursing. In add-on to her clinical piece of work, she is very active in the National Clan of Neonatal Nurses, has authored or edited several periodical manufactures and book chapters, and speaks nationally on a diversity of neonatal topics. She currently works in a enquiry chapters to improve healthcare for neonates. Sandy is also a clinical consultant with Medela. You can detect more data about Sandy and her work and interests at https://www.linkedin.com/in/sandy-beauman-0a140710/.
What Happens if You Feed a Baby Cold Breast Milk
Source: https://www.medela.us/breastfeeding-professionals/blog/warming-of-infant-feedings