Prematurity

• Mother will need assistance by the care team to develop a feeding plan to help meet her feeding goals along with close follow up care after discharge. The care team can include, but is not limited to:
  • Lactation Consultant
  • Nurse
  • Physician
  • Dietitian
  • Other appropriate therapies (occupational or speech therapy)
• Human milk fortifier will be needed for all very low-birthweight infants (those born at less than 1500 g in weight, also referred to as "VLBW infants")
• Careful nutritional monitoring for the infant is required; growth curves and metabolic (blood-chemistry) parameters will need to be studied.
• Skin-to-skin care provides stabilization for the infant and bonding opportunities for mom and other family members.
• Transition infant to the breast while weaning from gavage feedings.
• If bottle-feeding is necessary, early initiation of nonnutritive breastfeeding can be offered before each bottle-feeding and is beneficial for the premature infant to learn how to nurse.
• Consider the use of alternative feeding devices as part of developed feeding plan, when infant is stable.
• Nonnutritive feedings may provide an opportunity for the infant to suckle at the breast but, because of the weak suck, the baby may not receive a significant quantity of breastmilk.
• Double pumping with a hospital-grade electric pump, along with hand expression is recommended for establishing and maintaining ample milk supply.
  • The mother should begin pumping as soon as possible, ideally within the first hour postpartum (Parker 2015).
  • Each pumping session should continue until the flow of milk slows down or stops.
  • Research shows that mothers will need to be making ≥ 500 ml/day by day 14 as this is highly predictable to her baby receiving human milk upon discharge from the NICU. This expectation will also have an impact on her overall long-term milk supply (Meir 2017). Encourage the mother to pump about every three hours (or at least 8 times a day), including at night with no longer than a 6-hour interval between any pumpings.
  • The highest milk volume is obtained with double pumping and massage, hand expression after pumping. (Morton et al).

Clinical Guidelines

• Boies, E. G., & Vaucher, Y. E. (2016). ABM Clinical Protocol #10: Breastfeeding the Late Preterm (34-36 6/7 Weeks of Gestation) and Early Term Infants (37-38 6/7 Weeks of Gestation), Second Revision 2016. Breastfeeding Medicine, 11, 494–500.
• Noble, L. M., Okogbule-Wonodi, A. C., & Young, M. A. (2018). ABM Clinical Protocol #12: Transitioning the Breastfeeding Preterm Infant from the Neonatal Intensive Care Unit to Home, Revised 2018. Breastfeeding Medicine, 13(4), 230–236.
• Thomas, J., Marinelli, K. A., & Academy of Breastfeeding Medicine (2016). ABM Clinical Protocol #16: Breastfeeding the Hypotonic Infant, Revision 2016. Breastfeeding Medicine, 11(6), 271–276.

References

1. Asztalos, E. V., Kiss, A., daSilva, O. P., Campbell-Yeo, M., Ito, S., Knoppert, D., & EMPOWER Study Collaborative Group (2019). Role of days postdelivery on breast milk production: a secondary analysis from the EMPOWER trial. International Breastfeeding Journal, 14, 21. 
2. Campbell, S. H., Lauwers, J., Mannel, R., & Spencer, B. (2019). Core curriculum for interdisciplinary lactation care. Jones & Bartlett Learning. 
3. Holdren, S., Fair, C., & Lehtonen, L. (2019). A qualitative cross-cultural analysis of NICU care culture and infant feeding in Finland and the U.S. BMC Pregnancy and Childbirth, 19(1), 345. 
4. Lawrence, R. A., & Lawrence, R. M. (2016). Breastfeeding: A guide for the medical profession (8th ed.). Elsevier.
5. Meier, P. P., Johnson, T. J., Patel, A. L., & Rossman, B. (2017). Evidence-Based Methods That Promote Human Milk Feeding of Preterm Infants: An Expert Review. Clinics in Perinatology, 44(1), 1–22. 
6. Morton, J., Hall, J. Y., Wong, R. J., Thairu, L., Benitz, W. E., & Rhine, W. D. (2009). Combining hand techniques with electric pumping increases milk production in mothers of preterm infants. Journal of Perinatology, 29(11), 757–764. 
7. Parker, L. A., Sullivan, S., Krueger, C., & Mueller, M. (2015). Association of timing of initiation of breastmilk expression on milk volume and timing of lactogenesis stage II among mothers of very low-birth-weight infants. Breastfeeding Medicine, 10(2), 84–91.