In a message dated 10/12/2005 10:35:29 A.M. Eastern Daylight Time,
[log in to unmask] writes:
We're not there yet, though many have little pieces - some have
developmental care and "nesting" of premies in flexed positions in their
isolettes, some have limited kangaroo care, some have softer lights and
sounds or night and day simulation, some have great support for maternal
pumping (Rush comes to mind), and many "cluster" procedures to avoid
stressing the baby frequently, but no one in the US is putting these
techniques all together.
Catherine and others,
We do a pretty good job at this, but we still have to supplement these tiny
babies. To grow well at home, they would have to take in 180++cc/kg/d by
breast alone,and many of them have trouble taking in that amount consistently at
the point that many NICUs in the US try to discharge these babies--at 34-36
weeks CGA!! I believe that the discharge date for programs that are more
successful for total breastfeeding either have a discharge date closer to term
or have facilities for parents to stay 24/7 to breastfeed. Keep in mind that
these parents are used to EVERYTHING being monitored--so it's a real mind
blower for many of them to exclusively breastfeed without some type of support
like a baby weigh scale--which is expensive to rent and something else for them
to do. I believe I read something from Nancy Hurst and Paula Meier about
using this scale at home and that the mothers felt comfortable breastfeeding
without it by about two weeks.
Really, before term, it is the baby's lack of consistency at feeding that
matters. I have watched many babies feed and a fair amount of premies have
trouble feeding well at breast with every feeding for a while, until they mature.
I just went to a NICU reunion last week--there are many babies transitioning
to breast if the mother stays committed, despite the bottles given in the
NICU.
By the way, I agree with the person who said premies are adaptable with
whatever feeding--go figure, they've had to learn to adapt without the
placenta!!! Breastfeeding is much easier than that!
Maureen Allen RN, BSN, IBCLC
Boston, MA
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