Sick Infant in NICU or PSCN
The short and long-term outcome of the sick and preterm infant depends heavily on the early post-partum management of the mother. Delaying (waiting more than 6 hours post-partum) the initiation of frequent (8 sessions/24 hours) and effective expression of milk (hand expression coupled with electric pumping) may permanently compromise future milk production potential.
The most critical determinant of post-discharge breastfeeding, with all the associated health and developmental benefits, is the early establishment of a robust milk supply (>600 ml/day by 2 weeks) (Wooldridge, 2003; Bier, 2002; Hill, 1999; Flacking, 2003, Smith, 2003; Furman, 2002).
A mother’s emotional recovery is enhanced by her contribution to her infant’s recovery. Pumping and suckling stimulate multi-hormonal effects which contribute to physical recovery ( prolactin, oxytocin, insulin, glucagon, gastrin, cholecystokinin, cortisol, with a in BP and a in anxiety). With such high stakes, and because mothers feel so unprepared, overwhelmed and focused on the health of their infants, the maternity staff must assume responsibility for this intervention until she and her family can demonstrate a level of competency.
Seven “best practice” measures, described by the California Perinatal Quality of Care Collaborative, contribute to maximizing milk production.
- Inform the mother of the rational to pump early and pump often (See Appendix F: For mothers of preterm infants, watch on closed circuit TV: A Premie Needs His Mother, First Steps to Breastfeeding Your Premature Baby).
- Providing equipment, staff and logistics to pump early (within 6 hours of birth), pump often (8 times/24 hours with no more than a 5 hour interval at night.
- Provide a diary log, and begin recording every pumping and hand expression session.
- Teach adjunctive manual stimulation: breast massage and hand expression 8 times/day (See Appendix G).
- Facilitate early colostrum feeds.
- Provide skin-to-skin contact, whenever the mother is with her baby or as soon as the baby is stable enough to be transferred to and from his bed.
- Maternal discharge planning (See Educational Check List, Appendix E).
Suggested Information Followed by Script
1. The urgency and importance of deciding to provide milk vs. whether to breastfeed:
Maybe you did not have the chance to think much about breastfeeding, but would you be willing to provide your milk for your baby, at least during this hospitalization? Your baby needs something only you can provide. (Not: “Have you decided to breastfeed?”)
2. Protective role of human milk for preterm infants:
Milk is far more than food. It’s protection for your baby. Colostrum is more like a first vaccination.
3. Uniqueness of her milk for her infant:
Your milk is constantly CHANGING and specifically designed for your baby, with live cells, immunoglobulin, enzymes, and hormones .
4. The importance of starting pumping ASAP after delivery and appropriate goals:
Hand express your milk as often as a term baby would nurse, at least 8 times/day, beginning right from birth. Add pumping within 6 hours, 8 times per day, with no more than a 5 hour interval at night. This frequent breast stimulation is like "phoning in your order," so by the end of the first week, you’ll reach your goal of 20 ounces per day. Today we will help you learn to express your milk for your baby. We expect just drops today. We’ll catch those and take them to your baby.
Babies At Risk
- C-section Mothers
- Mothers with multiples
- Infants who have not latched-on or nursed effectively for 12 hours
- Mothers of NICU or PSCN infants
- Infants supplemented more than once in 24 hours
- Infants < 38 weeks or less than 6 pounds
- Infant with loss of 10% birth weight
- Mothers with breast surgery
- Mothers with a history of breastfeeding failure
- Antepartum mothers at risk of preterm delivery