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Learn how to promote a good milk supply for the mother of a sick or preterm infant during their hospitalization. Discover the benefits of breastmilk for preterm babies, pumping techniques, milk storage guidelines, the effects of Kangaroo Care on breastfeeding, and more.
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Caring for the Family Whose Baby Requires Hospitalization Identify at least one way to promote the establishment of a good milk supply for the mother of a sick or preterm infant.
COMPLETED WEEKS OF GESTATION AT BIRTH using last menstrual period SURVIVAL 21 weeks and less 0% 22 weeks 0-10%* 23 weeks 10-40% 24 weeks 40-70% 25 weeks 50-80% 26 weeks 80-90% 27 weeks >90% 30 weeks >95% 34 weeks >98% * Most babies at 22 weeks are not resuscitated because survival without major disability is so rare.
Drugs to stop labor (“tocolytics”) Ideal time for at-risk mothers to attend Preterm Birth Prevention Class Preterm Birth Timeline Gavage … Oral feedings Very preterm, VLBW
Teach about: • The importance of breastmilk for a preterm baby • Protection from infection • Protection from necrotizing enterocolitis • Greater tolerance of feedings • Reduced risk of later allergy • Improved eye function • Enhanced neurological development
Pump Operation • Help mother begin pumping by 6 hours after birth • Show massage techniques • Select flange size for best fit • Demonstrate hand expression - may be more effective for collecting colostrum
Frequency of Pumping • Pump 8 times per 24 hours • Every 2-3 hours during the day and once at night • May be able to go longer at night, depending on storage capacity
Length of Pumping Sessions • During the colostrum phase: express for 5-10 minutes • After Lactogenesis II: • pump until the flow slows down or stops • then pump for a few minutes more to “empty” the breasts completely • For most women, this takes about 15 minutes
Teach the science of milk supply • Keep prolaction levels high by pumping for 15 minutes at least 8 times a day Enhance oxytocin with warmth, massage, touch, food, and early skin-to-skin contact with baby • Drain milk glands well for higher fat content and faster milk production
Milk Storage Guidelines • Room temperature for 6 hours • Refrigerator for 48 hours (8 days for term, healthy babies) • Freezer for 6 months • Deep freezer for 12 months • Once thawed, use immediately or store in fridge for 24 hours • Feed warmed milk within 1-4 hours
Orientation to NICU pumping facilities, supplies, and resources
Effects of Kangaroo Care on Breastfeeding • Increases milk volume (680 vs 400 ml/day) • Increases breastfeeding incidence by 25-50% • Increases breastfeeding duration at all time points
Kangaroo Care’s Effects on Parenting • At 37 weeks gestational age: • Mothers showed more positive affect, touch, and adaptation to infant cues. • Infants showed more alertness and less gaze aversion. • Mothers reported less depression and perceived infants as less abnormal. Feldman, et al. Pediatrics July 2002
Kangaroo Care’s Effects on Parenting, continued: • At 3 months: • Mothers and fathers were more sensitive and provided a better home environment. • At 6 months: • Mothers were more sensitive and infants scored higher on the Bayley Mental Developmental Index and the Psychomotor Developmental Index. Feldman, et al. Pediatrics July 2002
Fat Content in Human Milk • Increases steadily until the end of feeding • Fat percentage ranges from 3-12% • Calorie count ranges from 16-35 kcal/oz • Can be measured by “creamatocrit”
Teach Parents Preterm Infant Cues STOP — Spit-up, Gag, Hiccoughs, BM grunts, Gas, Flaccid limbs, Gape face, Grimace, Apnea, Duskiness, Desaturation episodes WATCH AND WAIT — Halt, Finger splay, Tongue extensions, Fussing, Averting eyes, Respiratory changes, Frequent tremors & twitches, Frequent squirming GO AHEAD — Flexion, Hand on face, Sucking, Suck search (lips forward),Clasping hands, Grasping, Holding on, Raising eyebrows, Frowning, Looking at
Finger splay Halt sign Gaze aversion Preterm Cues:
Enhancing milk transfer • Pump just before or during breastfeeding • Massage breast • Use nipple shield • Meier’s 2000 study of 34 preterm infants • All consumed more milk nursing with shield • Average 18 ml (4 ml without shield )
Breastfeeding at home • Until 40 weeks post-conceptual age, expect: • Immature feeding behaviors • Weaker suck • Subtler cues • Plan to continue pumping • Plan for close lactation follow-up
Skin-to-skin contact as soon as possible Breastfeeding exclusively; wean from scale and pump Begin expressing milk within 6 hours Home with scale for determining intake at breast 10 1 2 9 Rooming-in for 24-48 hours prior to going home Early feedings of human milk 8 3 7 4 Cue-based breastfeeding with continued gavage Skin to skin as much as possible 6 5 Breastfeedings begin to “count” (start test weights) Sucking on the “emptied” breast (breast as pacifier) Adapted from Berlith Persson, Helsingborg Hospital, Sweden