Although it may be ideal if all infants could feed directly at the breast and receive milk at the perfect temperature with no preparation required, this is not feasible for all families. Many parents may need to be separated from their children because of return to work or school. Some infants are born critically ill, require hospitalization at birth and are not able to immediately receive enteral feeds. Some parents choose to pump because they do not want to have their infant at the breast or chest but want their baby to have benefits of an exclusive human milk diet. In my 10-step model for human milk and breastfeeding, step 3 is human milk management (Spatz, 2018). I recently taught a continuing medical education course and on reviewing the course evaluations, the most common item the participants wrote about was how they were unaware how critically important fresh milk is and this was their number one priority for making change in their clinical practice. Thus, the inspiration for sharing this information here.

For parents who have healthy infants, many have a goal of having a freezer filled with milk. It provides the family with peace of mind. However, as health care providers we should educate families to think of this milk as their "emergency supply." The goal for these families would be to feed the milk that was expressed the day before and only use the frozen milk if there was not enough fresh milk available.

For those infants who are critically ill at birth, fresh human milk also must be prioritized. If the child is going to be NPO for over 96 hours after birth before starting entereal feeds, the colostrum will need to be frozen and thawed once entereal feeds are commenced. Colostrum should be fed in the exact order that it was expressed for 48 to 96 hours depending on how quickly feeds are advanced and how much colostrum is available (Association of Women's Health, Obstetric, and Neonatal Nurses [AWHONN], 2021). Once the colostrum is fed, health care providers should prioritize a 100% fresh human milk diet for the hospitalized child (AWHONN, 2021). Both colostrum and mature milk are powerful antioxidants that provide essential protection for the infant's brain, lungs, and gastrointestinal system. Human milk improves brain development and developmental outcomes, decreases the incidence and severity of retinopathy of prematurity, and reduces the risk of necrotizing enterocolitis (AWHONN, 2021).

Antioxidant capacity of milk stored at -20 [degrees]C for 6 months compared with freshly expressed milk pumped by parents who had infants in the neonatal intensive care unit is significantly reduced (Sheen et al., 2021), a factor in the value of fresh milk for hospitalized infants. Sheen et al. (2021) conclude that these research findings may explain the nonuniform protection against oxidant disease in preterm infants fed human milk. These findings provide another reason for health care providers to refocus their education to families about the significance of feeding fresh milk. It is crucial to remember that human milk is alive and ever changing based on the environment of the dyad, so helping families to understand why fresh milk is critical is of paramount importance. Frozen thawed milk is better than the alternative of infant formula and should always be used if fresh milk is not available. Nurses play a key role in communication and education of families about the benefits of human milk and that providing fresh milk to their child will have the biggest impact on health outcomes.

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