There are some data to suggest that heat treatment of
expressed breast milk (EBM) at home may be implementable
but this complicated approach requires a great deal of
motivation from family and adequate support from the
health service. The approach is worth considering in preterm
neonates in hospital with additional risk factors such as
mothers who fail therapy or who are drug resistant. The bulk
of feeds would initially be by gastric tube, and this facilitates
heat treatment of EBM. Cup feeding of heat-treated EBM
may also be considered. It is probably safe to transition to
suckling directly from the breast with extended infant ARP
and maternal cART cover once the gut has matured and full
enteral feeds are established and well tolerated. Minimally
nutritive suckling may accelerate oro-motor maturation and
should be encouraged.