• Ensure there is a dedicated fridge and freezer for milk storage on ward
• Add date and time bottles removed from freezer/opened to bottle label
• Ensure 2 person check before administration to baby and/or addition of additives 

• See Breast milk expression guideline
• Advise mothers to bath/shower daily 
• Do not wash breasts with bactericidal detergent or soap 
• Before expressing milk, it is essential to wash hands thoroughly with soap and water and dry with a disposable towel
• Wipe breast pump with disinfectant wipe before use 
• Emphasise to mothers the importance of washing all breast milk collecting equipment properly before sterilising
• Wash equipment with hot, soapy water using bottle brush (not shared), rinse well and dry thoroughly with paper towels promptly after use. Sterilise before use. Discard bottle brushes on discharge
• Give all breastfeeding mothers information available from  www.unicef.org.uk/babyfriendly and www.bestbeginnings.org.uk/watch-small-wonders-online

• Give mother collection kit (sterilise before use) and tamper evident sterile bottles 
• Provide parents with patient identification stickers to label milk. Before giving a mother the patient identification stickers, positive identification must be made at the cotside/bedside by 2 people
• Clearly label milk from individual mothers and store in individual patient labelled containers and in a dedicated breast milk fridge (individual containers must not hold bottles from >1 mother)
• Blood and other pigments can discolour milk causing appearance to vary considerably

Where

• Store in designated fridge at 2–4°C. Freshly expressed breast milk can be stored for 48 hr before freezing 
• Breast milk can be stored for 3 months -20°C in designated freezer without a defrost cycle (in hospital)
• Freeze breast milk in small volumes with early expression so less milk requires defrosting and potentially less waste when establishing feeds
• Add date and time milk transferred to freezer to label
• Monitor fridge and freezer temperature twice daily using an indwelling maximum/minimum thermometer that is calibrated every 6 months. This temperature should be recorded – date/time, temperature and signature

How

• Place milk in an upright sterile container with airtight lid
• Ensure bottles labelled appropriately – see Record keeping
• Store labelled bottles in separate labelled tray in designated breast milk fridge/freezer (individual containers must not hold bottles from >1 mother)
• Wash trays stored in fridge daily in warm soapy water, rinse well and dry thoroughly 
• Clean trays between each use
• Gently agitate milk container to mix milk before use 
  
  • refrigerated milk separates with fat globules forming top layer 

• Use frozen milk in sequence of storage until enteral feeds established
• Thaw frozen milk in waterless warmer or in fridge (if warmer not available)
• If frozen milk needs to be thawed quickly (and warmer not available), hold bottle under cold or tepid water. Gently agitate and do not allow water to enter bottle via cap
• Discard any unused thawed milk (stored in fridge at 2−4°C) after 24 hr if defrosted in fridge or 12 hr if accelerated defrost

• Once removed from fridge, fresh or defrosted milk must be used within 2−4 hr (2 hr preferable)
• Fresh milk is preferable to thawed milk 
• Change continuous tube feeding (tubing between nasogastric tube and pump) every 4 hr
• To minimise fat loss, position syringe delivering feed in semi-upright position
• Bolus feeds - warm milk before giving using waterless warmer if available (to minimise fat loss) 
• Additives to be added to breast milk as close to feed time as possible
• Only warm volume of milk required for feed. Store remainder in designated fridge
• Before giving breast milk, carry out a 2 person check of the label and cross-reference with baby’s identity bracelet to ensure milk is not given to wrong child

Milk is often transported from:

• Mother's home to hospital:
  
  • transport in insulated container that can be easily cleaned 
  • encourage mother to use coolant block to maintain stable temperature
• Hospital-to-hospital:
  
  • use rigid container for easy cleaning (e.g. cool box) and fill empty space with bubble wrap
  • use coolant block to maintain temperature. Transfer to fridge/freezer if frozen as soon as possible on arrival in NNU/ward
  • document amount of milk both fresh and frozen, to ensure any milk defrosted in transit is not refrozen on arrival

• Wash hands thoroughly 
• Cover cuts and abrasions and wear gloves when handling breast milk

Covid-19 suspected/positive

• Wash hand thoroughly

• Cover cuts and abrasions and wear gloves when handling breast milk

• Wipe down the outside surface of ALL individual milk containers using universal disinfectant already in place at hospital 

• Set wiped containers in rack or on tray to dry (wet to dry ensures time for viricidal effect) before storing in refrigerator or freezer 

• Store in expressed breast milk fridge, in an individual, named box with lid 

• Use expressed breast milk within 48 hr of expression and place in expressed breast milk freezer if not used within allotted time

• Label all bottles/syringes with: 
  
  • baby’s name, hospital number and date of birth date and time of expression
• If mother is expressing milk at home, provide her with a supply of labels instructing her to add date and time expressed to each bottle
• If freezing MEBM label date and time frozen, and date and time of defrosting
• See Breastfeeding guideline

• Ensure parents take home all MEBM in the fridge or freezer. If some MEBM is left on unit and is in date, transfer from fridge to freezer immediately – inform parents to collect as soon as possible
• Give parents all MEBM on discharge and ensure all milk is checked for correct baby details: 
  
  • crosscheck labels on bottles with patient ID (second checker ideally mother) 
  • if parents not present carry out 2 nurse check and document in patient notes
• Discard milk stored in NNU freezer 1 month after discharge or as per local policy
• Discuss with parents the opportunity of donating any unwanted MEBM to local donor milk bank