Milk as a vehicle for oral medications: hidden osmoles

Objective:once critically ill, preterm infants have transitioned to enteral or oral feedings, it is common to mix oral medications with milk feedings. the osmolality of oral and intravenous drugs were tested in the 1980s and many were found to exceed the american academy of pediatrics (aap) recommended limit (400 mosm kg−1 h2o). many new milks and medications have entered the neonatal intensive care unit (nicu) since then. the objective of this study was to measure the osmolality of common milk-medication combinations administered in the nicu.study design:common milk-medication mixtures were analyzed for osmolality by freezing point depression.result:only elecare (30 kcal per oz) exceeded aap recommendations for osmolality in its unadulterated state. the addition of multivitamins alone resulted in an osmolality that exceeded 400 mosm kg−1 h2o. the cumulative addition of other medications resulted in some osmolalities >1000 mosm kg−1 h2o.conclusion:the coadministration of medications with milk products should be evaluated as a potential contributor to gastrointestinal intolerance of feedings in preterm infants.