Dr. Jane Morton lectures: " the late preterm infants are Great Pretenders " - they can on one side be sleepy, poor breastfeeders and it is clear from the beginning that they need help =- but they can also act as if they are good breastfeeders - but still, need help.. ((otherwise after a few days or weeks they start having weight problems or/and jaundice and the mother often has engorgement.))By help we understand to mean: added supplementation - hopefully colostrum - but if the mother does not succeed in expressing enough for each feed - then formula. We have the mother start expressing colostrum ( hand expression/pumping) as soon as possible. If the baby seems to be breastfeeding well, we don't push the formula, but definitely try to help the mother with expressing colostrum and giving it after the breastfeeding ( which we recommend limiting - not to let the baby feed for an hour or more..of course, making sure the latch is good, etc. ) At my hospital we have adopted the saying: Breastfeed, add supplement ( hopefully the breast milk that was expressed after the last breastfeeding period)and then pump - all this takes about one hour (then the mother has some times to rest and hasn't spent SO MANY hours of the day breastfeeding and pumping) - and do this, while skin to skin, every three hours or less. Depending on the age and weight we start this on the first day or on the second day. We made up this plan together with a leading lactationist in our area who sees such children once they go home. We tell the mothers to continue adding supplementation mother's milk to the breastfeeds until the baby is no longer Late Preterm ( around 38 weeks) and has started to gain weight nicely..and to start cutting down on the supplementations of breast milk gradually. Perhaps many of you will think it is unnecessary to tell all mothers of the Late Preterm that this is a necessary recommendation, - and of course if a lactationist sees and follow-ups on a mother one to one, including taking weights, etc. then maybe this isn't THE BEST advice for that particular mother, but since so many of the mothers do not go for follow-up breastfeeding advice after they leave the hospital, we believe that this is good advice to tell all of the mothers (to be on the safe side...we know that the late pretermers are the highest risk babies for rehospitalization because of weight problems and jaundice, especially with mothers that are interested only in breastfeeding.) I have been wanting to share this with you all for some time - and am eager to hear your comments.
All my best. Leslie Wolff IBCLC Israel
-----Original Message-----
From: Lactation Information and Discussion [mailto:[log in to unmask]] On Behalf Of Kerry N Zenich, RN, BC Peds, IBCLC
Sent: 03 March, 2012 20:13
To: [log in to unmask]
Subject: Imropoving Practice Late Preterm Infants
THIS WAS POSTED ABOUT ONE WEEK AGO...I HAVE NOT SEEN A RESPONSE, AND WE ARE IN THE SAME SITUATION..ANY IDEAS??
We are looking to improve practice as it relates to breastfeeding and the late preterm infant in the first 24-48 hours. Our goal is to develop a standard of care for these infants not admitted to the NICU. I have done an extensive literature search but have not found clear information as to when we should intervene in the first day or two. At what point in the first 24 hours do I need to supplement(EBM/Formula) if baby is asymptomatic, not latching or effectively feeding? Do we make that decision in the first hour or 2 of life or do we wait and watch? Any guidance and/or protocols you can share would be greatly appreciated.
***********************************************
Archives: http://community.lsoft.com/archives/LACTNET.html
To reach list owners: [log in to unmask]
Mail all list management commands to: [log in to unmask]
COMMANDS:
1. To temporarily stop your subscription write in the body of an email: set lactnet nomail 2. To start it again: set lactnet mail 3. To unsubscribe: unsubscribe lactnet 4. To get a comprehensive list of rules and directions: get lactnet welcome
***********************************************
Archives: http://community.lsoft.com/archives/LACTNET.html
To reach list owners: [log in to unmask]
Mail all list management commands to: [log in to unmask]
COMMANDS:
1. To temporarily stop your subscription write in the body of an email: set lactnet nomail
2. To start it again: set lactnet mail
3. To unsubscribe: unsubscribe lactnet
4. To get a comprehensive list of rules and directions: get lactnet welcome
|
