Hi Lisa.  You may want to look at Paula Meier's information from Rush 
Hospital.  Her studies show that even moms with low education levels do a 
great job with providing hindmilk and calculating the caloric density of 
their milk.  There has also been studies done that show that moms with 
preterm babies are more successful at breastfeeding if they rent a scale 
that measures intake.  Good luck!  Carolyn Schindewolf, IBCLC
----- Original Message ----- 
From: "Lisa Mandell" <[log in to unmask]>
To: <[log in to unmask]>
Sent: Tuesday, January 29, 2008 3:23 PM
Subject: help working with NICU


>I am a non-RN IBCLC working at a community hospital with 2500 births per
> year and a level 2 NICU (babies 32+ weeks). The staff in our NICU are
> knowledgeable about breastfeeding and quite supportive to the mothers.
> However, there seem to be some practices that are not always the most
> effective or evidence-based for contributing to breastfeeding success. For
> example, breastfeeding is not initiated until babies are able to 
> bottlefeed
> successfully (or "nipple," which drives me crazy; they talk about 
> "nippling
> 60% of feeds"). Once it is initiated, breastfeeding is limited to 2x/day,
> with feeds of expressed breastmilk (often fortified with Neosure) at other
> feeding times; this is also the standard instruction for discharge. When I
> asked about using hindmilk to increase weight gain when mother is pumping
> sufficient volumes, I was told it was too difficult for mothers/NICU to 
> do.
> I'm sure there are many other opportunities for improvement.
>
> My question is how to start approaching the NICU staff in a way that will
> not have them raise their defenses, but open up to learning? I have read
> through the Academy of Breastfeeding Medicine's protocol for transitioning
> from NICU to home, but I'm not sure how to share it. It is my 
> understanding
> that babies are discharged shortly after they are able to take all feeds 
> by
> mouth and maintain weight gain (when other health measures are all good), 
> so
> I'm not sure about the viability of such recommendations as transitioning 
> to
> unfortified human milk for one week prior to discharge and measuring 
> weight
> gain. At this point, there is much I don't know about NICU protocols (I
> asked yesterday and got some information from a NICU nurse, but she
> indicated that there are no written protocols). So I can use help with 
> what
> questions to ask, who to talk to (what position), what research or other
> materials to provide, how to offer information, and anything else you 
> might
> be able to share.
>
> Thank you!
>
> Lisa Mandell, MBA, IBCLC
> Havertown, PA USA
>
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