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Brief Summary of Breastfeeding Sick Babies

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I have just attended a  powerful and interesting conference : “Breastfeeding sick babies”by Professor  Dr. Diane L. Spatz  from The Children’s Hospital of Philadelphia , USA.  She is very energetic and can lecture for the entire day without showing any tiredness!  I have learned one secret from her –don’t eat too much if you have to lecture in the afternoon because  too much digestion of food will direct blood flow to your GI tract instead of your brain. 
               This is the brief summary of what I have learned during the 3-day conference.
               Breastfeeding is not a lifestyle choice but a medical intervention. We have to look at breastfeeding in a new perspective : human milk is  the first vaccine and medicine for sick babies. Premature babies are vulnerable to infections so their own mothers’ milk will provide them with specific antibodies and  immunoglobulin against  infections their mothers had experienced before  through .entero-mammary pathway.  Live white blood cells in breast milk will help protect the baby from infections. In this way breast milk is the first vaccine the baby gets from its mother.
               Premature babies need ventilators to support their respiratory system  ,they also need their mothers’ milk to provide the very best nutritional start to support their gastrointestinal system . The ventilator supports the lung until it is mature enough to function by itself. Breast milk protects and support the mucosa of infant’s GI tract from oral mucosa through colon and anus until they are  strong enough. Infant’s gastro-intestinal tract can tolerate breast milk better than formula milk . Data show that 10-20%  of formula fed infants will acquire NEC(Necrotizing enterocolitis) compared to 2% human milk fed infants. NEC is a serious complication in premature infants that could cause death. The premature  babies  own mother’s  milk is most suitable to them because the energy  carbohydrate , protein  and lipid content  are higher than term mother’s milk. Human milk also have natural  DHA and ARA  for optimal brain cells maturation  . Anti-oxidants in breast milk protect the baby’s lung against serious injury.
                So why don’t we strive to get breast milk to those very sick newborns so that they can survive through the most difficult time of their lives? Parents can make informed choice after they realize the huge  benefits their babies will get from  their own mother’s breast milk.
               The next step is helping mothers to establish and maintain milk supply by initiate massaging the breast as soon after birth as possible. Because the sick babies cannot suckle the breast immediately so we have to mimic the suckling by manual expression or mechanical pumping of the breast every 2-3 hours .During the first  4  days , don’t expect a lot of milk as the colostrum produced during the period will be  in very small amounts. Save the colostrum separately,  they  are very precious!
               Breast milk from the mothers of sick newborn in NICU has to be managed: systematic  labeling, bin system for storage of individual breast milk.  If mother can express or pump her breast at the bedside the breast milk can  be delivered freshly to the baby immediately or within 4 hours. Or the milk can be refrigerated and should be used in  96 hours. If the milk could not be consumed within 96 hours , it should be frozen for further use as an emergency supply. Mothers are encouraged  to visit their baby daily or at least every 4 days so that we  always have  fresh milk available.
               At first when the baby cannot receive enteral and oral feed   , fresh colostrum  is used to start mouth care as soon as possible after delivery. The rest of the colostrum is frozen until the baby is ready for oral feed.  Initiation of enteral feed by using colostrum for 24- 48 hours so that the baby get the immunoglobulin A and healthy gut flora . Avoid formula milk altogether during this period.
Bolus feeds are preferred becausethey promote  normal cyclic surges of gut hormones .If baby cannot tolerate bolus feed ,continuous feed should be considered  using the upright syringe position and agitate syringe hourly. New research find out that even with optimum positioning  nutrients are lost –especially triglycerides which can be loss  by 33% and total caloric intake may be in jeopardy.
                The next step is the transition from tube feeding  to feeding directly from the breast.Skin to skin care is a method that leads to breasfeeding success. Even if the babies are still on ventilator  nurses can help mother hold them close to their heart on the mothers’ chest. Begin non-nutritive suckling  first  after the babies are extubated. Then gradually transfer to oral feed at the breast. In some cases with difficulty in transition to breast, ultra-thin nipple shield is used to increase the duration of sucking bursts and the volume of milk consumed.
               Innovations in the provision of human milk. There are variations in milk volume produced by individual mother. Variation in fat content also occurred. Expressed  breast milk in the evening have higher fat content than in the morning .The human milk management center in Children’s Hospital of Philadelphia develop milk laboratory technology to use fractionated human milk for optimum growth of sick newborns in NICU .
               The best part of the conference are the examples of several cases of  sick newborns whose survival  depend on the dedication of the staff and mothers .Dr. Diane Spatz  can motivate the audience by showing them examples of success stories .  She told a story of one premature baby who had birth asphyxia and was critically ill. While the baby was on ventilator the mother was encouraged to pump breast  milk for her child right away even if the chance of survival was very slim.  She told the audience the reason why : if the baby survives he will have his mother’s milk available ,  pumping the breast is the only thing  only the mother can do for her baby  and  even if the baby did not survive she can donate her milk to  the milk bank. The mother used  cotton buds soaked with her colostrum to wipe inside her baby’s mouth every  2 -3  hours. There were days when the staff prepared her to say good bye to her baby because he was so sick. But miraculously the baby pulled through all the obstacles . He  survived and grew up  to be a cute little toddler. The broad smiles  and bright eyes of both mother and child embracing each other  can bring tears to the audience as well as the lecturer. Human milk  really  matters!
Dr. Siripatana Siritanaratkul
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