I thought you all would be interested in this posting on NICU-NET today:
---------- Forwarded message ----------
Date: Sat, 19 Jul 1997 13:06:20 +0400
From: "DR. ARUN NAIR" <[log in to unmask]>
To: "NICU NET" <[log in to unmask]>
Subject: Breast feeding and NICU

I have been reading with interest all the discussion about breast feeding,
cup feeding and transition from tube to breast etc. I must point it out
that while all of us   agree in principle to the concept of breast milk and
feeding techniques, I find that the most sceptical people in the unit when
it comes to practcality are us, the physicians. I am a member of the
national BFHI committee in Oman. We have a very high breast feeding rate
amongst our babies, not only in our unit but in the whole of the Sultanate
of Oman. The whole country has been declared baby friendly as per the
strict guidelines laid down by the UNICEF. In the process of getting the
hospitals baby friendly, the most difficult area we came across was the
neonatal units. The reason being lack of proper guidelines in this special
care situation. We therefore came out with a policy for special care
situation, I believe this the first of its kind and is approved by the
UNICEF. The most difficult people to be convinced were our surgical
colleagues especially with regards to cup feeding and non nutritive
sucking. There are several grey areas in this regard. There are some
research work going on and hopefully in a couple of years time there will
be enough scientific evidence to support the use of cup feeds as a regular
method in preference to artifical nipples.
I am attaching a copy of our guidelines outlining the process of  switching
from tube to cup/ breast feeds.

        GUIDELINES FOR CHANGING FROM NG TUBE TO BREASTFEEDING.

        The decision to start putting babies on to breast is based on many factors
but generally if the baby is free of all problems and basically a feeder
and grower, he/she should be put to breast for contact with each NG feed
for a few minutes.  However, the baby should continue to be topped up
fully.  For a healthy preterm this can be done usually when he/she has
attained a weight of about 1.4kg. Gastric aspirate should continue to be
checked to ensure that babies are not getting overfed.  This programme
should be continued till he/she has attained a weight of 1.75 to 1.8 kgs.

        From then on the following regimen is suggested.

        Substitute two NG feeds with breast feeds without top up at 12 hrly
intervals; if wt gain is satisfactory for one to two days, change to 8th
hrly and progressively increase the frequency at 1-2 day intervals to 6th
hrly and then 4th hrly interval till the baby is successfully feeding on
breast.

        If at any point the weight gain is not found to be satisfactory then do
not increase the breastfeeding frequency.  Consider switching back to the
previous step and re-start all over again.

        Note:  There may be babies who are smaller or larger which are exceptions
to this protocol and may need individualized feeding program.


If any one is interested in the 'BFHI policy for special care situation',
you could get it from the UNICEF, PO Box 3787 Ruwi,  PC 112,  Muscat,
Sultanate of OMAN.

Arun Nair MD
NICU
Royal Hospital
Muscat
Sultanate of OMAN

------------------------------