Gonneke and Ann write:
Depending on the place and severeness of the burns baby may not be able to
drink at breast. Mom will have to pump. If mom can create and maintain an
oversupply, she might consider (in dialoque with staff) to feed hindmilk. This
will provide her child with extra high energy food, combined with much needed
vitamins for healing and not adding extra burden in coping with intestinal
problems due to alien nutrients from fortifier.
If baby is feeding at breast she might want to consider pumping foremilk out
before baby starts nursing... and possibly using an NG tube to feed
hindmilk...
~~Update:
I talked to someone from U of Rochester who suggested before giving HMF(
though they already started) to have baby evaluated by a neo or pedi dietician
to determine caloric needs of a little burned person, mom took this suggestion
well. She pointed out that it has not been studied for fullterm healthy
babies with burns and may or may not be a good choice to increase calories since
there is more than just more calories there. We aren't sure how it got
decided to push this, but they pushed harder when they saw it was not healing well.
We did talk about if the burn is really deep, no matter he ate, it might not
heal any better and the skin graft would be needed. We also talked about
lactoengineering with mom's own milk. Supply is good and she's willing. The
issue is whether increasing fat/calories is needed or extra protein - hopefully
the dietician can be of help. Also she might check if the HMF is sterile, or
if it actually might be a source of bacteria itself. It should prove itself
needed by the dietician somehow, and hopefully the minimum amt necessary. An
SLT in the hospital suggested only bottlefeeding once a day due to nipple
confusion, and gave mom a Haberman and an SNS. Baby nurses fine, actually. Mom
says he did wince intitially but is ok now. Not sure how he will be after a
mandibular area graft. My concern was more overfeeding with the bottle if he
only got once a day and needed to get all the powder in one shot, and that the
SNS might clog, but if it worked, go for it. I am only for tools that work
easily and make life easier for mom and baby, but it might get him off bottles.
Since he went into this with no sucking/feeding issues, I hope that with
nice, occasional paced feeds on a slow system, he will do fine. He has been so
far anyway. I also just gave a ton of support for how helpful it is for him to
keep getting as much of her milk as possible and keep nursing. She said they
wanted her to massage the area and keep stretching the skin - I said that we
both know that babies open their mouths nice and big and are actively
engaging bigger muscles when they breastfeed and so normal feeding at breast is
actually therapeutic for him. She felt good about this.
Thanks for the input and just for "listening".
Peace,
Judy
Judy LeVan Fram, PT, IBCLC, LLLL
Brooklyn, NY, USA
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