Gill O’Connor, Infant Feeding and Breastfeeding Development Coordinator:

Breastfeeding Babies in the Neonatal Unit

Breastfeeding is beneficial for sick or premature babies for the same reasons as it is for babies born fit and healthy at term. Mothers can be supported with establishing and maintaining breastfeeding in a variety of ways. Fathers and extended family have an important part to play by encouraging and giving praise to the mother as breastfeeding or providing expressed milk for a premature or sick baby can be time consuming and frustrating.

Admission to the neonatal unit results in separation of mother and baby and interrupts the normal process of building a relationship when a baby is discharged home. One of the ways that parents can take the opportunity to get to know their baby is through ‘kangaroo care’. For mothers that cuddle their baby either skin-to-skin, tucked in their shirts or with baby dressed, this positive touch helps stimulate milk supply. If the baby is happy, they can be cuddled for as long as both are comfortable. This mutually enjoyable experience for mother and baby has been shown to be more effective in early establishment of feeding as well as achievement of exclusive breastfeeding in pre-term babies and better weight gain. Mothers who have had the opportunity to provide kangaroo care for their infants describe feelings of being needed, increased confidence in knowing their infants and a sense of their role as a mother. Some studies [1] [2] have shown that neurodevelopmental outcomes, and maternal psychological well-being are improved when a mother practices kangaroo care.

When baby is too premature or poorly to feed at the breast the mother can express her milk and give through a tube.  Staff can help mothers to learn this new skill which may be done by hand or using a pump.  In the first few days mothers produce thick, yellow, nutrient rich colostrum in very small volumes. Stress and anxiety can affect milk supply and it is not unusual it to take a while for milk to build up. Every drop counts, and fluid requirements for these infants are very small and as benefits are dose-related so every feed counts. The properties in breastmilk that aid digestion and absorption of nutrients and gastrointestinal function are important. Due to the babies immature defence systems they are more susceptible to infections including necrotising enterocolitis (NEC), a serious condition where tissue in the bowel becomes inflamed. Breastfeeding can help reduce the risk of NEC and breastmilk may also be helpful when a baby is recovering from NEC and is able to start milk feeds again, so mothers can continue to express and build up a supply of expressed breastmilk (EBM) for when their baby recovers.

The Lancet Child and Adolescent Health Journal published an article this month that found that babies whose parents are integral to their care thrive. The study found that “Weight gain, breastfeeding and reduced parental stress and anxiety are all associated with positive neurodevelopmental outcomes, suggesting that integrating parents into the care of infants at this early stage could potentially have longer-term benefits.

This can only be encouraging for families that want to be able to care for their babies in this way.  Breastfeeding is something that only a mother can do for her baby, and when a baby is poorly mothers have told me that this helped them to feel they were able to help their baby in a way that nobody else could do and minimise their feelings of helplessness.

It is important that mothers get support from family, friends and neonatal staff. The opportunity to spend long periods of time with their baby to establish breastfeeding and build relationships for both maternal and infant health is difficult to achieve alongside home life. Pre-term birth can also bring negative consequences for the development of the father/infant relationship [*] but helping their partner achieve the goal of giving breastmilk and participating in care can build this bond. BLISS, a charity for premature and sick infants, have a website with information related to premature infants and contact details for local support groups. At ABSS there will be both peer support and professional breastfeeding support available from the spring. In the meantime the health visitor or midwife will be able to support and advise.

The neonatal unit can be overwhelming and frightening, so supporting the family unit is crucial. Remember at the heart of it all is the baby, who is often surrounded by equipment and medical staff, but they are still a little person with a need for comfort and love. This is why it is quite nice to see that ‘Pleasurable feeding for premature infants: Food for thought!’ is the topic for an international conference in Stockholm in March.

 

[*] Fathers’ experiences with their preterm babies admitted to neonatal intensive care unit: A multi-method study Authors Alberto Stefana,First published: 14 February 2018 DOI: 10.1111/jan.13527

 

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