QUEEN ELIZABETH HOSPITAL
(NEONATAL INTENSIVE CARE UNIT & SPECIAL CARE BABY UNIT)
GUIDELINES IN HANDLING EXPRESSED BREAST MILK

A breastfeeding room is designated for mothers to express milk in both units. Electric breast pumps and sterile pumping kits are available in limited supply for mothers to use in hospital. Mothers are encouraged to use their own pumping kits whenever is possible. Mother are advised to clean up the electric pump after each use.

PERSONAL HYGIENE

Mother should maintain good personal hygiene with daily shower or bath including hair washing. Daily change of clothes and underwear are encouraged. Hands and nails should be washed with soap and water thoroughly before expression.

1. Please inform us immediately when you feel unwell such as high fever, mastitis, painful & swollen breasts. We will discuss the milk expressing manage plan with you.

EXPRESSION OF MILK

To establish lactation successfully, mothers are encouraged to hand express as soon as possible or within 2-4 hours post-delivery ideally. Hand expression should be done 2-3 hourly and aim at 8 – 12 times daily

EXPRESSION OF MILK BY BREAST PUMP

1. Hands and nails should be washed with soap and water thoroughly before expression.
2. Assemble the sterile collecting kit; take care not to touch the inside of the collecting bottle.
3. Place flange of pump onto the breast firmly with the nipple centered.
4. Start with low suction pressure and increase it gradually according to your comfort. Pump one breast for about 5-7 minutes, it usually takes a few minutes for a milk-ejection cycle to complete, or until the flow of milk slows down and then switch to another breast for next 5-7 minutes.
5. Repeat the process once or twice more. With good milk-ejection reflex, a 20-minute's pumping or hand expressing would be optimal. Limit the procedure time to not more than 30 minutes. The milk produced in early lactation, especially colostrums, contains anti-infective properties that are most beneficial to your baby. Milk should be collected in volume that corresponds closely to the amount needed for each feed.

STORAGE OF EXPRESSED BREAST MILK (EBM)

1. Glass milk bottles , plastic milk bottle or sterile milk cup are for EBM storage. The EBM should be put into the refrigerator/freezer without delay.
2. To protect the preterm infant from acquiring CMV infection, baby whose gestation age less than or equals to 32 weeks should have the expressed breast milk frozen right after expression and should be kept in a frozen state during transport in order to inactive the CMV.
3. No mixing EBM of different time in the same bottle nor add fresh EBM into frozen one. Maintain all bottle seal tightly
4. Milk volume of each bottle should be just enough for each feed and prepared for daily use. Syringe should be used for ≤ 10mls per feed especially for the first few days of lactation.
5. All milk bottles are put in a covered container. The container should be in the top shelf of the refrigerator and away from other food to reduce risk of contamination.
6. Fresh expressed breast milk can be stored at room temperature for 4 hours for immediate use. For preterm infants whose gestation age is 32 weeks or less, the expressed breast milk should be kept frozen right after expression to minimize the CMV infection.
7. Otherwise, all EBM should be put into the refrigerator/freezer without delay
8. Fresh expressed breast milk should be encouraged for feeding so that the infant receives the most benefit from the milk.
9. Fresh EBM can be stored in the 4 C fridge up to 48 hours and bring to ward within 24 hours after pumping.
10. All fresh EBM should be put in a freezer (-20°C) for 3 months when not being used within 24hours

Breast Milk	Room To	Fridge 2oC - 4oC	Home fridge -4oC	Freazer -20oC
Freshly expressed	4 hours	48 hours	2 months	3 months
Defrosted in fridge	4 hours	12 hours after defrosted	No refreeze	No refreeze

TRANSPORT OF EBM

1. Protect EBM bottles with clean waterproof bag to prevent them from directly contacting with ice.
2. Use icebox with ice cubes for keeping EBM frozen or cool during transport.
3. We only accept those EBM that are stored and transported in proper conditions and are not expired. If the frozen milk is thawed during transport, it should be treated as chilled milk and preferably used within 12 hours.
4. Mother is encouraged to bring in EBM sufficient enough for the day only.
5. Mother could enquire the amount of feed daily use and bring in sufficient amount for that day and the remaining should be frozen for the future use.

THAWING OF EBM

1. If frozen milk needed to be used immediately, thaw milk under cold running water. This must be done with extreme care not allowing water to enter the bottle.
2. Alternatively, frozen milk can be quickly thawed with luke warm water (﹤60℃) for immediate use.
3. Frozen breast milk may be placed in the refrigerator to thaw gradually. The defrosted milk must be labeled clearly the expired date and time. Frozen milk, which has been defrosted, must be used within 12 hours.
4. Defrost EBM must not be re-freeze. Once only and discard any unused EBM.
5. Do not use microwave or hot water to thaw or reheat EBM. Heating milk in microwave ovens has been shown to be uneven and can create "hot spots" , also shown to destroy most of its anti-microbial factors.

ADMINISTRATION OF EBM

1. Hands should be washed thoroughly before and after handing EBM
2. Infants should receive fresh breast milk whenever possible, because of the enhanced activity of cellular components. Fresh EBM contains optimal anti-infective properties that would have been destroyed or reduced by freezing. Frozen breast milk that have expressed in earliest time should be used first
3. For infant's ≤ 32 weeks gestation, frozen EBM would be used, first in-first out approach would be adopted. The earliest freezing one would be used first.
4. Breast milk normally separates into milk and cream on standing. Gently swirls the container to mix the milk before feeding
5. Use towel to dry the wet bottle before feeding
6. Discard any unused or warmed EBM after feeding

DISINFECT THE COLLECTION KIT AND MILK BOTTLE AT HOME

Disassemble all parts and wash as soon as possible. Soak them for a few minutes before scrubbing. The utensils should be washed and scrubbed with detergent and hot water, using a bottlebrush and then rinse thoroughly under running water.
Disinfect utensil by boiling method

1. Immerse the bottles and all spare parts including the tong underneath water
2. Utensils should be boiled for a further 5-10 minutes after boiling
3. Use the sterilized tongs to remove the utensils from the water
4. Drain and air-dry the utensils
5. Put assemble bottles in a clean container well covered with lid and keep in a cool place or fridge
6. Re-sterilize the utensils after use, or if stored for more than 24 hours

STEPS FOR LABELLING OF EBM BOTTLE

1. Write clearly your baby's name, bed number, date and time of expressed breast milk on the label
2. Secure the written label against the milk bottle with plastic wrap
3. The loosed ends of the wrap should be fixed with adhesive tape
4. Obtain your baby's gum label from hospital staff
5. Affix a the gum label on top of the plastic wrap after verification of your baby's identity
6. Use adhesive tape to secure your baby's label