"Please, no flames. I realize that I am inexperienced in working  w/preemies
and their needs, but this mother approached me for assistance. She  was ER
C/S at a local hospital with no LC (in an area where I practice), and  the
baby was air-lifted to a NICU more than 100 miles away.  Considering  that
the NICU does not have an LC and that she has not waivered in her desire  to
BF this baby, (her first), I want to do all I can to empower her"
 
Dear Niki,
Certainly no flames toward you but I have never heard of more inappropriate  
breastfeeding management in a NICU. I worked in a high risk OB center where 
many  of our moms were on Mg and we never withheld colostrum or breastmilk from 
the  sick or premie infants, never mind continuing that practice long term. 
The  only thing I can imagine her doing is asking the MD and the dietician for 
their  references on how breastmilk would not be the optimal nutrition for this 
 baby. She could also ask them what the community and national standards are 
for  feeding premature babies. They'll be hard pressed to come up with 
information  recommending withholding mother's own milk in favor of fomula for a  
premie.  Is she on some other medication (of which there are very few)  that is 
contraindicated in breastfeeding? Otherwise I can't fathom this  situation. 
Even in NICU's which are relatively  breastfeeding  unfriendly I have never heard 
of recommending formula over mother's  own milk to a healthy, growing premie. 
Short of mom being on an  incompatible med or baby having some kind of 
metabolic disorder this makes no  sense and I would ask the powers that be for their 
references. You could  also look at the toolkit for feeding premies that 
Nancy Wight was involved in  writing.
 
Oh, and 1 ml equals 1 gram and there are approximately 30 ml per oz.  Intake 
for a premie is calculated on ml/kg/day and kcal/kg/day. The  neonatologist 
will be making these calculations.
 
Transition to breast could happen right now. When baby is showing feeding  
cues, mom puts him to breast. A test wt. is very helpful in assessing intake. If 
 he doesn't take at least 2/3 or more of his feeding the rest can then be  
gavaged.Can't imagine this NICU has a Baby Weigh Scale, however. We usually  
start premies with one feeding per day, but this baby now being 34 weeksadjusted  
age could well be able to nurse more than once per day. The idea is to 
establish  breastfeeding before he gets a bottle.
 
I'm so sorry this mom is having this unecessary hassle and this baby is  
being denied her breastmilk.
 
Kathy Boggs, RN, IBCLC 
 
 

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