April writes:

I'm working  with a client who was told by NICU staff to not nurse her 
preemie (born at 33  weeks) longer than 30 minutes or so because he'll loose the 
calories he is  getting from breastfeeding. However, being a preemie, he falls 
asleep at the  breast a lot and is happy to nurse while sleeping. I have never, 
ever heard  that and checked all my resources and still can't find   anything.


~~ I wonder if they are saying that when they actually mean that  spending 
long periods of time  (which they define at 30 minutes or  more) at breast may 
be too stressful for a preemie who may have stamina  issues, and may not be 
strong enough to transfer adequate amounts of milk before  fatiguing out, and 
then would end up underfed if they just fall asleep/shut  down unsatiated. I 
would also be careful of allowing a premature baby to  expend energy, over a 
period of time, on any form of feeding without seeing  if there is any milk 
transfer. Babies who come early can often have real issues  with stamina, so they may 
want to cap breast time until they can be sure that  the baby is working 
efficiently enough. Although it is probably more important  to actually look at 
the baby, not the clock, by assessing rhythmic swallowing,  sucking bursts, 
latch position, and test weights, etc., not all NICU nurses feel  competent or are 
encouraged to do this, and NICUs are often about  walking the line between 
being patient with learning normal feedings skills,  while keeping in mind the 
potential compromising things these babies often have  to deal with and 
developing general rules to deal with them.  It would  be important to make sure that 
this baby is actually "nursing while sleeping",  meaning actually 
transferring milk, or is he just hanging out, enjoying  closeness, signaling milk 
production, all good and important things to be sure,  but not actually transferring 
decent amounts of milk. Time at breast without  significant milk transfer is 
not bad, unless it means the baby is then too  fatigued or disorganized to feed 
adequately after that. So, I think I know the  concept they are trying to get 
at, they are just not wording it right, in my  opinion.
 
Peace,
Judy  

Judy LeVan  Fram, PT, IBCLC, LLLL
Brooklyn, NY,  USA




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