Hello Pamela and all!

Here in Finland it is a common practise to give premature babies who are 
under 32 weeks / birthweight less than 2000g HMF with EBM until their weight 
is 3500g-4000g i.e. near 40 weeks. But of course they can be at the breast 
as often as they wish at home and the fortifier can be given in very small 
EBM volumes before or after breastfeeding. Only we use BMF which is powder, 
not HMF which is liquid if I am correct, BMF is easy to give in very small 
amount of EBM. Of course it could be very hard to give it often for example 
6-9 doses of BMF per day, it is easier if the baby needs only a couple of 
doses per day. Some times our Neos can give less fortifier if the 
breastfeeding is too hard at home with it or mothers are allowed to quit 
giving it sooner in favour of breastfeeding.

I think this is a hard dilemma: what is optimal nutrition for premature 
baby? They definately need many nutritiens more than there is in breastmilk, 
but since breastmilk is different than artificial milk, how to figure out 
what is optional with breastmilk? Premature babies are individual also with 
their feeding tolerance and growth patterns, I wish many times that our Neos 
would be more individual with their orders with different babies and 
mothers. What I wish more is that our system would be more breastfeeding 
friendly, very few of our babies will be breastfed after a couple of months 
because they are not allowed to be at the breast often enough and the nost 
of RNs don´t have enough education about breastfeeding management. This will 
eventually change, our NICU is going to be renowated after a couple of years 
and the whole care philosophy will change towards family oriented NICU. Then 
the parents will be there more, 24/7 will be possible and kangaroo care and 
breastfeeding also will encrease. Then we nursery wards need to be ready to 
admit these family cared babies and continue the same care plan until they 
are ready to go home. We launched our special WHO 20 hour course last year 
which is desinged for nurses who work with babies and neonatal wards, I and 
the two IBCLCs are teaching it.

I would like to share my latest succesful story: in our ward a 31+ weeker 
(born at 28+) twin was at breast last week for the first time, she weighted 
less than 1000g. She and her sister have been showing rooting for a while 
and sucking pacifiers so I talked with the mother (and Neo) and said that 
she is ready to start being at the breast during kangaroo care sessions and 
her sister will be soon (sister is still most of time with NCPAP). Next time 
she was rooting during kangaroo care, she was put to the breast and she took 
the breast and latched for a couple of sucks before falling beautifully 
asleep. When I started working there 2,5 years ago, babies were allowed to 
start breastfeeding at 33-34 weeks and only a1-2 times a day. (And I would 
not have been competent enough to try it then.)

Best wishes,
Pia Ruohotie, RN and breastfeeding counsellor
from Helsinki, Finland Europe

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