26/11/2021
Some great info from Bloem MomDoc. Breast feeding is an important part of NICU
🍼Feeding in the NICU🍼
Often moms feel hopeless when their little one is in NICU. They feel that they aren’t in control, and they can’t do anything to help their little one get better. But when it comes to feeding your baby in the NICU, you as a mom can contribute the most to getting your little one better.
🍼What are the types of feeding your baby might receive?🍼
💧TPN💧
If your baby is very ill, they might start feeding with TPN. This is an abbreviation for Total Parenteral Nutrition. This is where they receive their nutrients and feed through a “drip” or line inserted into your baby’s veins.
🥛Enteral nutrition🥛
This is where your baby receives milk into their gut. It might be given through a tube from the nose to the stomach (nasogastric tube) or through the mouth (orogastric tube). They will initially start with tiny amounts like 2ml every 4-6 hours. They will be monitoring for any signs of gut problems or if some of the milk given wasn’t digested. They will calculate the amount of milk needed by using your baby’s weight. These feeds are ideally done with breastmilk but can also be done with donor breastmilk or specialized formulas. They can also add a breastmilk fortifier in your breastmilk to make it more nutrient-dense and provide what your baby needs to grow optimally.
🤱🏻Latching/bottle feeding🤱🏻
A speech therapist, dietician, or lactation consultant can eventually assist you in feeding your baby when the naso- or orogastric tube is removed. You will continue feeding your baby like this at home after discharge.
🍼Why is breastmilk best for a baby in NICU?🍼
♥️They tolerate full feeds easier by maturing the gut faster.
♥️It prevents infections and sepsis.
♥️It prevents them from getting Nectrotizing Enterocolilits (NEC), where the bowel wall is destroyed by inflammation and infection.
♥️It prevents Retinopathy of Prematurity, which is an eye condition premature babies get.
♥️Prevents chronic lung diseases
♥️Prevents developmental delays
♥️Prevents most re-hospitalisations after discharge from the NICU.
🍼When should you start expressing breastmilk for your baby in the NICU?🍼
Within the first hour! The few drops of your colostrum are liquid gold, and they can start feeding your baby this as soon as they are ready. In the first few hours, hand expressing your colostrum out might be easier than using a pump.
🍼Which breast pumps are best?🍼
A manual pump will be tedious to use with only your hands doing the work. The fl**ge size usually isn’t adjustable, and you can’t control the suction.
Personal electric pumps usually don’t have as much suction power as hospital-grade ones, but they are getting some features as technology progresses. Fl**ge sizes can generally be changed on some pumps.
A good hospital-grade electric double pump will be the best. It will reduce the time pumping with maximal productivity. It maintains high suction with good outputs. Try aiming to get a pump with adjustable cycles to mimic the baby’s sucking. It should have an adjustable suction power with a closed system and should be easy to sterilize.
This is up to personal taste, and many brands claim to be the best. Do your homework, read reviews, chat with your NICU nurse and ask around.
🍼Is a second-hand pump okay?🍼
Usually, only hospital-grade pumps and closed system pumps are re-usable. If you re-use other open-system pumps, the motors can become weak. They can be contaminated by the previous user’s milk or water, creating mould in the tubing. Your baby’s health is the highest priority, so use the correct and clean pump!
🍼How often and long should you pump?🍼
You should aim to pump 8-10 times in 24 hours. Pump 10-20 minutes per session with a maximum of 30 minutes when your milk becomes established. Even if you stop seeing milk coming while pumping, continue “dry pumping” for another 3-5 minutes, which will stimulate the breasts.
Just like a non-NICU baby’s mom, you should be getting up during the night as well. You need to do a few nightly pumping sessions to keep your supply up and try not to go more than 4-6 hours without pumping. Milk supply tends to be better when you naturally wake up at night, like going to the loo or being uncomfortable with engorged breasts, rather than setting the alarm. But set the alarm to wake you if 4-6 hours have passed since you went down for the night.
🍼How much milk should your goal be to pump?🍼
When your milk supply is established in those early days, by day 10, you should be aiming to pump more than 750ml per day, but not less than 350ml. If you have multiples, you should be aiming at 800-950ml in 24 hours by day 14.
This sounds like a lot, but getting your supply up so early, sets you up for a good supply for long-term breastfeeding. Research has shown that if you have a good milk supply by 2 weeks after birth, you are likely to have a good supply later in your breastfeeding journey as well. Having a lot of milk will also assist with latching your baby, as they will be enticed with more milk.
🍼How can you get the milk flowing?🍼
You need to get a let-down, and you can achieve this by thinking of your baby or looking at pictures of them. Try some breast massage with a warm compress.
🍼How can you increase your milk supply?🍼
Power pumping is a great way of upping your milk supply. This mimics a baby going through a growth spurt, and that is constantly breastfeeding. You are tricking your breasts into producing more milk.
💬Pump for 20 minutes and then rest for 10 minutes.
💬Then pump for another 10 minutes and rest for another 10 minutes.
💬Then pump for 10 minutes and then stop.
You can power pump up to twice a day for 3 days. Only start power-pumping when your milk is well established to prevent engorgement and oversupply.
🍼What if you struggle with pumping and breastfeeding?🍼
Get help from a lactation consultant. They are trained to assist with breastfeeding and have hours of practical experience helping moms. Many NICUs can recommend a lactation consultant in the area.
🍼What if I really can’t get the expressing thing right?🍼
The next best thing is donated breastmilk. Speak to your healthcare team at your NICU to get hold of donated breastmilk at the SABR. If there is no donated milk available, your doctor will guide you in further decisions on feeding your baby.
🍼More breastfeeding tips for the NICU🍼
🔔Try to get some rest as much as your can. When you aren’t visiting your baby in the unit, your should be pumping and resting.
🔔Try to do Kangaroo Mother Care as much as allowed with your baby.
🔔Get in enough fluids and try to eat healthily.
🔔Ask for help! A lactation consultant should be on your speed dial.
🍼BloemMomDoc is passionate about breastfeeding!🍼
See my other posts on the topic of breastfeeding here:
https://www.facebook.com/100050595844490/posts/374528317577027/
Thank you to Carey Haupt, from Carey Haupt Lactation Support and director of My Breastpump, for assisting me with most of the info in this post by providing the lecture she did at the annual breastfeeding conference this year.
Pic by freestocks on Unsplash.
