Hi Heidi,
Don't worry, I'll be gentle....
1. The best milk for a premie is his mother's own milk. This mother should be pumping ASAP after delivery. If she does not feel well, her sister or husband can certainly pump her. Lots and lots of massage. Every 2 hours around the clock if they can manage it...?Reglan or Domperidone--we have noticed that mothers who have received Reglan intraop have earlier milk production. (There's a study for someone...)
2. The colostrum that they get should be used to provide mouth care for this baby even before he begins trophic feeds. The good effects of colostrum can start working for this baby even before he begins eating.
3. Trophic feedings are the minute amounts of colostrum which are fed to micropremies to line their guts so they tolerate feedings better and have less incidence of NEC (necrotizing enterocolitis-a bowel infection which can be catastrophic).
4. The milk should be given in the order in which it is pumped, like nature intended it.
5. A premie of this age probably will max out at 12-15cc per feeding every three hours, give or take. That's 4 ounces/day. If this mom pumps like heck for a week or so, she may end up making AT LEAST 4 ounces/day by the end of the week. Feedings for these babies generally begin at 1cc every 3 or 4 hours. They advance by 1 cc every 12-24 hours. If this milk is carefully aliquotted and NOT wasted, she may get AT LEAST two weeks of feedings from her own milk.
6. My experience is that mom needs to recover from childbirth--at least be stabilized--before she begins aggressive treatment. You might get a week or so of breastmilk, before you can't use her milk. Way better than nothing, and probably still better than her sister's milk since her baby is term.
7. Preterm milk is higher in all of the nutrients THIS baby needs. The composition changes at about one month out to mature full-term baby milk. Also, with mom doing kangaroo care, she will provide NICU-specific antibodies to protect this fragile baby from infection. So, if this aunt does provide milk for this premie, she should consider a little kangarooing with her niece/nephew.
8. Who would know whose milk she has brought in?
9. But seriously, milk banks generally test for HIV, Hepatitises, CMV..call any milk bank and they could provide you with that information.
10. Depending on the treatment, maybe mom would consider pumping and dumping until the meds are out of her system, and use her milk she provides between rounds of chemo? Does anyone know if that's possible? (Just throwing that one out for discussion)
11. Find a breastmilk-friendly Neonatologist--probably not too hard. They hate sepsis and NEC, too. Many hospitals have patient advocacy departments. Maybe the OB and oncologist would like to help here, too.
Good luck and hug this mother for me.
Maureen Allen RN, BSN, IBCLC
Brigham and Women's Hospital
Boston, MA
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