Tammy:
A shrine!  I would rather have the cash for breastpumps for my indigent Moms
- but thanks for the thought.

We really don't have any policy specific to the NICU, except for how to
handle Mom's milk, how to order donor milk.  All the rest are general newborn
policies. A year or two ago I spoke in Salt Lake City Utah, and I believe
they developed a set of "policies" for the NICU.  Also, 10 years ago I saw a
set of policies from Georgetown University - their lactation program.

If you take the research-based statements from Paula Meier's work you can
form a policy. eg: (not in logical order - just off the top of my head)
-Lactation consultant to see EVERY infant/mother pair in NICU within 24 hrs
and follow them at least weekly.
-Mother to be given peer support resources/pump resources/information.
-Start trophic feeds ASAP.
-Always use FULL strength EBM.
-Kangaroo care as soon as stable. (ie no weight or gest age criteria)
-"Dry" (nonnutritive) breastfeeding as soon as stable. (ie no weight or gest
age criteria)
-Always put baby to breast BEFORE attempting bottle-feeding.
-If supplements needed - gavage preferred.
-If too mature for gavage, use feeding method of Mom's choice.
-Use EBM in order pumped X 3 weeks, then fresh milk.
-Start pumping within 24 hrs (preferably within 6 hrs) post partum.
-Pump to mimic normal term newborn feeding pattern (ie 8-12 X 24 hrs) for
first week, then at least 5-8 X/25 hrs, including through the night.
-Pre-post weights to assess BM transfer q feed (Sweden), q day, q.o.d., prn -
you choose- no literature
-Dr. Meier's nursery allows Mom and RN to decide when to increase feeds - in
my nursery it is the doc who writes the orders (but usually the RN and Mom
tell me what they want!)
I could go on and on but the hour is late - even in California.
Hope this helps.
Nancy

Nancy E. Wight MD, FAAP, IBCLC
Neonatologist, Children's Hospital, and Sharp Mary Birch Hospital for Women
Medical Director, Lactation Services, Sharp HealthCare
San Diego, CA, USA

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