fresh vs frozen milk for NICU baby

[Prensa]

question I can't quickly find the answer to:

my baby was born four weeks ago and due to surgery and stuff has just started to "feed" this week. They started her very slowly to make sure there were no gut issues, and today she is up to 16ml/hour via NG tube plus they also made it through my colostrum stash and are moving on to frozen BM. I'm still pumping every three hours and get about 12 oz each time and I'm wondering if there is any proven benefit to giving her fresh stuff at this point (she may start on a bottle as soon as tomorrow) as opposed to the stuff that's been frozen for a month?

I seem to recall that milk is "alive" but couldn't find any real links (I'm cuddling right now )

so tell me if I should ask them to use my current milk and just hang on to the frozen for now. I could even give them hind milk only if that would help.

any BTDT? TIA!

[mischievium]

At the NICU where I used to work as a nurse, if there was a choice of fresh versus frozen, we would give whatever colostrum that was frozen first (and possibly the transitional milk) and then give fresh and only dip into the frozen if we were out of fresh. I believe there are some components of breast milk that are damaged by the freezing/ reheating process, which is why fresh is preferable, but I'm having a hard time finding a source (via google) that explains what might be damaged, though I've found several websites, including Dr. Sears that say fresh breast milk is preferable to frozen.

Does the floor have a dedicated LC? If so, I would start by talking to her regarding their policies on the use of breast milk. If they don't have an LC, talk to the baby's nurse and ask if there's a reason they would use frozen over fresh-- honestly, I don't see why they would, it's much more work for the nurse to have to defrost the milk than just use fresh/refrigerated (assuming you're pumping enough to keep up with her needs).

[bandgeek]

Yes, fresh is better. I would always take in my milk as soon as I pumped (I'd often pump there at least once a day) and they'd use the fresh for the next feed. They were always happy to do fresh rather than frozen because they didn't have to get it out beforehand and wait for it to thaw.

I would suggest hind milk only if the baby has trouble gaining weight. And even then it depends on the baby. It's harder to digest than just regular breastmilk. We did that with my DD because she was struggling with weight gain, but like 2 weeks later she started puking it (when we turned her rate up).

I would try to get her fresh milk at least once a day but you do want to use up the frozen stuff too so you don't waste it. But with pumping 12 oz each time, you might end up wasting some! If it looks like it might go to waste, see if you can find another baby to donate it to. Also, storing the milk in the deep freezer will make it last considerably longer. So only store enough there that you need (and a little extra just in case) and store the rest at home. If you don't have a deep freezer and it looks like you might be pumping for a while, consider investing in one.

[mischievium]

Originally Posted by bandgeek

I would try to get her fresh milk at least once a day but you do want to use up the frozen stuff too so you don't waste it. But with pumping 12 oz each time, you might end up wasting some! If it looks like it might go to waste, see if you can find another baby to donate it to. Also, storing the milk in the deep freezer will make it last considerably longer. So only store enough there that you need (and a little extra just in case) and store the rest at home. If you don't have a deep freezer and it looks like you might be pumping for a while, consider investing in one.

You can ask the hospital what kind of freezer they use, but we definitely had a dedicated deep freeze freezer on unit. But we also had somewhat limited space (as in, space usually wasn't an issue, but occasionally was). For the mamas who's milk supply far outstripped what we needed to use for the baby (usually because there was frozen stockpile before we could start feeding the baby and their fresh supply was meeting or exceeding what we needed to give the baby), some would take it home or, if they also had too much at home, they would, as bandgeek suggested, donate it. Though the donation was not mom to mom at the hospital, it was often to a milk bank. Again, if the unit or hospital has an LC, they can probably give you info about donating extra milk or even possibly arrange it for you (I know our LC used to arrange to have extra donated milk shipped to our local milk bank).

[Bokonon]

I agree that after the colostrum is exhausted, fresh would probably be preferable, but I would want the yellow-er frozen milk used first, personally.

Also, 12 oz. every 3 hours is a TON of milk, and if you keep that kind of supply, it's going to be very hard to transition your baby to the breast. I had an oversupply and overactive letdown when my son was in the NICU, though not even as much as yours, and it took 2 months once he came home to transition him to full-time breastfeeding. Your baby will never consume 96 oz. in a day - the average breastfed baby takes in between 19-30 oz. per 24 hours. Unless you plan on exclusively pumping and/or donating your milk, I would highly recommend slowly cutting back on how much you pump, to closer match your baby's intake. You could space your pumping sessions out a little bit more, or only pump until your breasts feel softer, use cold compresses to ease engorgement if necessary. No one told me while DS was in the NICU that 10 oz. every 3 hours was going to be a bad thing - I just assumed the more, the better! When DD was born, I only pumped 6x a day once my milk came in, because I didn't want to end up with oversupply again, especially because she didn't even take any feedings until she was 3 days old, and until she came home, my supply was still at least twice as much as she was taking. But I regulated my pumping and got her fully breastfeeding after 1 week at home (2.5 weeks old).

Good luck, HTH!

[Prensa]

thanks for all the replies!

I never even thought about making too much milk, thanks for bringing that up! I'll try to find the LC to talk to, in the meantime they've decided to use human milk fortifier in my milk so I'm trying to figure all this out...

[spughy]

How premature was your baby? I don't think there's anything wrong with human milk fortifier - it's recommended for very premature babies (up to 34 weeks I think? Not sure on the exact gestational age at birth). Near-term preemies often do fine without it, if they have no other health concerns, since breastmilk for near-term preemies is "fortified" right out of the tap, but natural fortification can only go so far and I think that for babies born before 34 weeks, human milk fortifier is actually a very good thing and improves outcomes a lot.

[DocsNemesis]

I'm late to this thread and only noticed it because she said in another thread her baby came home today (YAY!) but I believe her dd was 38 weeks and only in the NICU because of a heart defect. HMF seems kind of odd for a full term, normal sized baby. Maybe because of the heart defect they felt the need to add it? I don't know.