Dear Nikki,

It is very unfortunate to hear that you are encountering such hostility towards human milk at this NICU. The benefits of human milk/breastfeeding to prems, especially the tiniest and most vulnerable, are well-documented and various. Benefits include a decreased risk of necrotizing enterocolitis, sepsis, and retinopathy of prematurity as well as greater tolerance of enteral feeds and better physiologic stability during feeds (i.e., there are fewer episodes of apnea, bradycardia, and desaturation while breastfeeding compared to bottlefeeding). Furthermore, the nutritional composition of preterm milk is especially well-suited to the preterm infant in the first few weeks and continues to provide immunoglobulins and other protective factors that protect the gut even after it's composition changes to that produced for term infants. There is also support in the literature for the use of banked donor human milk for those babies who are unable to receive their mother's own milk for a
ny variety of reasons. Additionally, oral stimulation with human milk can be an important aspect of developmentally appropriate care for the preterm infant.

As for scheduled feeds...there is some interesting research that indicates that a semi-demand method of feeding helps babies to achieve full enteral feeds quicker. This methods uses the baby's cues to determine whether to offer an oral feed, provide the feed by gavage, or stop the feed if the baby is exhibiting stress cues and provide the remaining volume by gavage. 

I am not sure if I understand the comment re: using artificial milk substitutes to achieve adequate volumes to prevent side effects from meds. Are they concerned re: renal function? Could adequate fluid volumes not be achieved through the use of human milk and/or parenteral nutrition/fluids? Could you perhaps elaborate? I am also unsure of this neo's evidence base for his statement regarding the unsuitability of human milk for term neonates.

Dru Antoniuk MA, BScN, RN (in an NICU)

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