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Subject:
From:
"Catherine Watson Genna, IBCLC" <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Wed, 12 Oct 2005 10:34:14 -0400
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Cee,
Breastfeeding is NORMAL work for a NORMAL infant. The babies that Dr. 
Wight and other neonatologists work with are very tiny preterm infants, 
with very low stamina, lower muscle tone, lower neurobehavioral 
organization, and lots of environmental stressors impinging on them in 
an effort to keep them alive.
The way that preterm infants are handled does go a long way in helping 
them to breastfeed. Skin to skin care, gentle handling, developmental 
care, reduction of noise and lights in the NICU, early experience with 
the just pumped breast- all these things help a small preterm infant to 
breastfeed. For infants receiving standard NICU care, breastfeeding 
might be more than their nervous systems can handle.
Then there are the "co-morbidities" - conditions that can go along with 
or stem from prematurity that further compromise the baby - brain 
bleeds, BPD from ventillators, sepsis and other infections. These make 
it even harder for baby to feed well.
There are also a lot of individual factors. I've had very young infants 
fully breastfeeding in my practice (as early as 32-34 weekers) and 
infants who were already past term who could not manage it. There is a 
place for bottles in the care of preterm infants in the context of how 
care if provided in US nurseries. If we could get Marina Markovich's 
model of a NICU (Dr. M is a neonatologist in Austria, she found that 
they had to vent far fewer babies if they avoided seperating them from 
mom at birth and otherwise stressing them, and with the lower rates of 
vents, there were lower rates of brain bleeds etc.) entrenched in the 
US, or Dr. Hedberg-Nyqvist's in Sweden  where preterm infants are gently 
and gradually transitioned to breast starting as young as 26-28 weeks 
gestational age, perhaps this would be different. But as we do it "now", 
some preterm infants do far better on bottle than breast, even with 
carefully paced bottle feeding (I should say ESPECIALLY with carefully 
paced bottle feeding). The challenge is to weave the new research about 
the sensory and environmental needs of infants with the technology we 
need to keep some of them alive and come out with an optimal balance. 
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 Watson Genna, IBCLC  NYC

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