What Happens if a Baby Drinks Cold Milk

Warming of Infant Feedings

Sandy Beauman, MSN, RNC-NIC

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The practise of warming chest milk for feedings has long been a standard in the NICU.  In no small function, this is related to the fact that much of the expressed breast milk has been previously frozen, requiring at to the lowest degree thawing. 

I of the earliest publications apropos warming of infant feedings looked at infant's acceptance of absurd or cold feedings.1  Most infants (67%) accepted cold feedings and no departure in growth patterns was constitute between the groups fed common cold, cool or warm milk.  These infants were likely bigger, healthier infants than what nosotros commonly meet in the NICU today.  In spite of the finding that infants "accepted" the milk, the practice of warming milk for feedings following freezing or refrigeration has been a long-standing practice for both in-hospital and home feeding.  In that location are several theoretical reasons to warm the milk prior to feeding.  In the very low birth weight infant, feeding of cold milk may lead to changes in torso temperature, although this has never been well-researched.  Studies have attempted to show furnishings of feeding temperature variations and issue on metabolic rate, residuals, effect on torso temperature and growth patterns.  Gonzales did show an increment in residuals related to cold feedings but this has not been replicated since and was a fairly modest sample size.2  Many other practices accept changed as well since that time.  So, the benefit of warming feedings and to what platonic temperature is however without good evidence.  There is, all the same, no evidence that this is harmful.  And then, the accepted practise is to warm to some as yet, undefined temperature. The Human Milk Cyberbanking Clan advocated warming feeds to body temperature for premature infants, particularly those at risk for necrotizing enterocolitis.three  For term infants, feedings may exist given at torso temperature, room temperature or straight from the refrigerator.   In attempts to determine 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 36.2°C.4 Lawlor-Klean, Lefaiver, Weisbrock demonstrated a range of milk temperature from 22°C to 46.4°C.five Over-warming may exist as detrimental as under warming.  Over warming may lead to deterioration of some do good from human milk and/or furnishings on baby temperature.  Nether warming may lead to effects on digestion and/or body temperature of the infant.    Is information technology possible that milk warmed to a higher temperature should not be left as long in a continuous feed, due to concerns nigh bacterial growth?

Warming may occur in a multifariousness of methods.  Articulate recommendations have been adopted regarding avoidance of microwave warming.3  Past recommendations have included a preference for warming nether "running water".   This is not ordinarily practical in the real world, though.  The length of time required to thaw or warm a feeding to an acceptable temperature is an unrealistic fourth dimension for the nurse to spend at the sink holding a bottle under running water!  Thawing milk may also occur in a variety of ways.  Thawing at room temperature, in the fridge or in warm water are all used.  If milk is thawed in warm water, information technology often reaches room temperature or warmer earlier taken from the water bathroom.  Once the milk has been warmed to room temperature or across, it should not be returned to the refrigerator or used for more than than a few hours, usually a maximum of 4 hours.6  If thawed milk is non going to be used within this iv hour window, it should be thawed but not warmed.  Thawing in the fridge or with a controlled mechanism such as is now available on the market should be done to avert warming.  All of these available methods require time to thaw.  Therefore, feeding our infants requires advance planning for the twenty-four hour period or the shift, including the next 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 bath likewise an unreliable finish temperature includes possible contamination of the feeding.   The consequence of contamination is worth word.  Tap water often contains an "acceptable" level of bacteria that in the normal, healthy population is non of business concern.  However, contagion of a feeding to be given to a high risk neonate could certainly cause a trouble.  Tap water often contains an "adequate" level of pseudomonas and other bacteria we recognize every bit lethal in the NICU.  Fifty-fifty a pocket-size amount of these bacteria can exist life-threatening to our loftier-risk infants.  In some recent performance improvement work done in California to decrease blood stream infections, it was found that one suspected cause of claret stream infection in at to the lowest degree xv% 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 possibly enhancing growth, what effect does the extended hang time of a pre-warmed continuous feed or feed over time have on the ultimate temperature of the milk when it reaches the infant?  If milk is infusing over 30 minutes to 4 hours with tubing extending from the pump to the feeding tube both inside and outside the incubator, temperature volition change over this time menses, more than or less, depending on room temperature, length of infusion fourth dimension and incubator temperature.

As with many other neonatal bug, 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 have an result 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 effect on overall torso temperature?  One study institute no thing what the milk temperature was, trunk temperature increased.  This is likely related to the increment in metabolic charge per unit following feeding.  Is this also true in premature infants and does information technology extend to very premature infants?  Probable, the small feedings we requite to the very premature infant does not crusade this increase in metabolic rate and therefore, body temperature.

We often think of feeding babies as a simple, almost mindless chore in the NICU.  As we detect out more and more nigh their nutritional needs and training for feeding, we know this, as much as the delicacy of gas substitution during lung illness, requires finesse and attention.  The proper diet at the proper fourth dimension is critical for tiny babies whose brains are requiring the majority of the nutrition.

References:

ane. Gibson JP. Reaction of 150 infants to common cold formulas. J Pediatr. 1958; 52: 404–406

two. Gonzales, I, DurveaEJ, Vasquez E, Garahty Due north Effect of enteral feeding temperature on feeding tolerance in preterm infants. Neonatal Network.  1995;14(three):39-43.

3. The Human being Milk Banking Association of North America, Inc. (2011). All-time Practice for Expressing, Storing and Handling Human being Milk in Hospitals, Homes and Child Care Settings. HMBANA: Westward Hartford, CT.

4. Dumm M, Hamms M, Sutton J, Ryan-Wenger Due north.  NICU breast milk warming practices and the physiological effects of breast milk feeding temperatures on preterm infants. Advances in Neonatal Intendance. 2013;thirteen(iv):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 intendance unit. Advances in Neonatal Care.  2013;13(5):E1-E10.

6. Robbins Due south, Meyers R. Pediatric Diet Practice Group. (2011). Babe feedings: Guidelines for preparation of human milk and formula in wellness intendance facilities 2nd ed.  American Dietetic Association.

Looking for additional reading from Sandy Beauman's professional person perspective?
View her web log entry Chest Milk Employ.

Well-nigh the Author

Sandy Sundquist Beauman has over 30 years of experience in neonatal nursing. In addition to her clinical work, she is very active in the National Association of Neonatal Nurses, has authored or edited several periodical manufactures and book capacity, and speaks nationally on a multifariousness of neonatal topics. She currently works in a research capacity to better healthcare for neonates. Sandy is also a clinical consultant with Medela. Y'all can find more data about Sandy and her work and interests at https://www.linkedin.com/in/sandy-beauman-0a140710/.

What Happens if a Baby Drinks Cold Milk

Source: https://www.medela.us/breastfeeding-professionals/blog/warming-of-infant-feedings

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