x At least 80% of the mothers who have decided not to breastfeed or need to supplement breast milk, report that they have been offered help in preparing and giving their babies feeds, can describe the advice they were given, and have been asked to prepare feeds themselves, after having been shown how.
x At least 80% of the clinical staff can describe how non-breastfeeding mothers can be assisted to safely prepare their feeds, or can describe to whom they refer mothers for this advice on their shifts.
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References
1. Sweet L. Breastfeeding a preterm infant and the objectification of breastmilk. Breastfeed Rev 2006 Mar;14(1):5-13.
2. Weimers L, Svensson K, Dumas L, Naver L, Wahlberg V. Hands-on approach during
breastfeeding support in a neonatal intensive care unit: a qualitative study of Swedish mothers' experiences. Int Breastfeed J 2006;1:20.
3. Sisk et al, Breast Milk Expression and Maintenance in Mothers of Very LBVBW: Supports and barriers
4. Meier PP, Engstrom JL, Mingolelli SS, Miracle DJ, Kiesling S. The Rush Mothers' Milk Club:
breastfeeding interventions for mothers with very-low-birth-weight infants. J Obstet Gynecol Neonatal Nurs 2004 Mar;33(2):164-74.
5. Ahmed AH, Sands LP. Effect of pre- and postdischarge interventions on breastfeeding outcomes and weight gain among premature infants. J Obstet Gynecol Neonatal Nurs 2010 Jan;39(1):53-63.
6. Cattaneo A, Davanzo R, Worku B, Surjono A, Echeverria M, Bedri A, et al. Kangaroo mother care for low birthweight infants: a randomized controlled trial in different settings. Acta Paediatr 1998 Sep;87(9):976-85.
7. Gathwala G, Singh B, Singh J. Effect of Kangaroo Mother Care on physical growth, breastfeeding and its acceptability. Trop Doct 2010 Oct;40(4):199-202.
8. Hake-Brooks SJ, Anderson GC. Kangaroo care and breastfeeding of mother-preterm infant dyads 0-18 months: a randomized, controlled trial. Neonatal Netw 2008 May;27(3):151-9.
9. Hurst NM, Valentine CJ, Renfro L, Burns P, Ferlic L. Skin-to-skin holding in the neonatal intensive care unit influences maternal milk volume. J Perinatol 1997 May;17(3):213-7.
10. Wooldridge J, Hall WA. Posthospitalization breastfeeding patterns of moderately preterm infants.
J Perinat Neonatal Nurs 2003 Jan;17(1):50-64.
11. Flacking R, Nyqvist KH, Ewald U, Wallin L. Long-term duration of breastfeeding in Swedish low birth weight infants. J Hum Lact 2003 May;19(2):157-65.
12. Flacking R, Hedberg NK, Ewald U. Effects of socioeconomic status on breastfeeding duration in mothers of preterm and term infants. Eur J Public Health 2007 Mar 28.
13. Bonet M, Blondel B, Agostino R, Combier E, Maier RF, Cuttini M, et al. Variations in
breastfeeding rates for very preterm infants between regions and neonatal units in Europe: results from the MOSAIC cohort. Arch Dis Child Fetal Neonatal Ed 2010 Jun 10.
14. Hill PD, Aldag JC, Chatterton RT. Effects of pumping style on milk production in mothers of non-nursing preterm infants. J Hum Lact 1999 Sep;15(3):209-16.
15. Furman L, Minich N, Hack M. Correlates of lactation in mothers of very low birth weight infants.
Pediatrics 2002 Apr;109(4):e57.
16. Hill PD, Aldag JC, Chatterton RT, Jr. Breastfeeding experience and milk weight in lactating mothers pumping for preterm infants. Birth 1999 Dec;26(4):233-8.
17. Hill PD, Aldag JC, Chatterton RT. Initiation and frequency of pumping and milk production in mothers of non-nursing preterm infants. J Hum Lact 2001 Feb;17(1):9-13.
18. Okechukwu AA, Okolo AA. Exclusive breastfeeding frequency during the first seven days of life in term neonates. Niger Postgrad Med J 2006 Dec;13(4):309-12.
19. Yamauchi Y, Yamanouchi I. Breast-feeding frequency during the first 24 hours after birth in full-term neonates. Pediatrics 1990 Aug;86(2):171-5
20. Hopkinson JM, Schanler RJ, Garza C. Milk production by mothers of premature infants. Pediatrics 1988 Jun;81(6):815-20.
21. Morton J, Hall JY, Wong RJ, Thairu L, Benitz WE, Rhine WD. Combining hand techniques with electric pumping increases milk production in mothers of preterm infants. J Perinatol 2009 Nov;29(11):757-64.
22. Becker GE, McCormick FM, Renfrew MJ. Methods for milk expression by lactating women.
Cochrane Database Syst. Rev. 2008 Oct 8;(4):CD006170
23. Jones E, Dimmock PW, Spencer SA. A randomised controlled trial to compare methods of milk expression after preterm delivery. Arch Dis Child Fetal Neonatal Ed 2001 Sep;85(2):F91-F95.
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24. Ohyama M, Watabe H, Hayasaka Y. Manual expression and electric breast pumping in the first 48 h after delivery. Pediatr Int 2010 Feb;52(1):39-43
25. Nyqvist KH, Farnstrand C, Eeg-Olofsson KE, Ewald U. Early oral behaviour in preterm infants during breastfeeding: an electromyographic study. Acta Paediatr 2001 Jun;90(6):658-63.
26. Nyqvist KH. Early attainment of breastfeeding competence in very preterm infants. Acta Paediatr 2008 Jun;97(6):776-81.
27. Nyqvist KH, Sjöden PO, Ewald U. The development of preterm infants' breastfeeding behavior.
Early Hum Dev 1999 Jul;55(3):247-64.
28. Raju NTNK, Higgins RD, Stark AR, Leveno Kj. Optimizing care and outcome for late-preterm (near-term) infants: A summary of the workshop sponsored by the National Institute of Child Health and Human Development. Pediatrics 2006;118:1207 -14’
29. Meier PM, Furman LM, Degenhardt M. Increased lactation risk for late preterm infants and mothers: Evidence and management strategies to protect breastfeeding J Midwifery & Women’s Health 2007;52(6):579-87
30. Sweet L. Expressed breast milk as ‘connection’ and its influence on the construction of motherhood for mothers of preterm infants: a qualitative study. Int Breastfeed J 2008;17(3):30 31. Sweet L. Breastfeeding a preterm infant and the objectification of breastmilk. Breastffed Rev
2006;14(1):5-13
32. Flacking R, Trustful bonds: a key to “becoming a mother” and reciprocal breastfeeding. Stories of mothers of very preterm infants at a neonatal unit. Soc Sci Med 2006;62(1):70-80
33. Sisk PM, Lovelady CA, Dillard RG, Gruber KJ. Lactation counseling for mothers of very low birth weight infants: effect on maternal anxiety and infant intake of human milk. Pediatrics. 2006 Jan;117(1):e67-75.
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breastfeeding support in a neonatal intensive care unit: a qualitative study of Swedish mothers’
experiences. Int Breastfeed J 2006;1:20
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Step 6. Give newborn infants no food or drink other than breast milk, unless medically indicated.
Breastfeeding is the normal way of providing young infants with the nutrients they need for healthy growth and development (1, 2), including preterm and ill newborns (3, 4). Breast milk is species-specific, and all substitute feeding preparations differ markedly from it, making breast milk uniquely superior for infant feeding. Breast milk-fed preterm infants receive significant benefits with respect to host protection and improved developmental outcomes compared with formula-fed preterm infants (3, 5). For example, the risk of septicaemia in extremely preterm infants was reduced in those infants who received very early full human milk feeding (4). In situations where mothers' own milk is not
available, provision of pasteurized, screened human donor milk is the next best option particularly for ill or high-risk infants (3, 5, 6).
In situations where human donor milk is not available, provision of commercial formula is the best option (3). Whenever possible, preterm formula is recommended for the nonhuman-milk fed infant with a body weight of less than 2000 g, followed by iron-fortified standard infant formula until the infant is 12 months of age (3). The WHO revised the acceptable medical reasons for use of breastmilk substitutes in 2009 (7).
Use of fortifiers varies between and within countries and indication remains controversial. As low birth weight infants may cope well with large milk volumes, increasing volumes of milk intake as early as possible to volumes of (or above) 200 mL/kg and day - a proactive feeding strategy - may be an alternative to the addition of fortifiers as intervention to promote infant growth (8).In extremely preterm infants, high volume intake of mother’s milk fortified with individualized supplementation of protein and minerals has been associated with attainment of adequate infant growth (9).
For the purposes of this adaptation of the BFHI 10 steps, a fortifier is considered a medication (the same way that vitamins, mineral supplements, medicines and intravenous solutions are allowed). Thus, an infant receiving a fortifier can be considered exclusively breastfed for the statistics purpose, if powdered fortifier is mixed with breast milk (10). When fortification of mother’s own milk is prescribed, the mother should be informed about the reason for this supplementation and that her milk remains the optimal nutrition for her baby, in order to protect her intention to continue lactation/breast feeding (11).Powdered fortifier, when compared to liquid fortifier, appears to be preferred by parents and have a positive effect on the duration of breastfeeding (12). However, because of logistical difficulties in systematical provision to breastfed babies with fortified mother’s milk, this strategy may interfere with breastfeeding when practiced post-discharge (13).
Standards
6 a Newborns are given no food or drink other than breast milk, unless medically indicated 6 b Mothers are informed about prescription of fortification/other additions to their milk in a way
that protects their perception of mothers’ own milk as optimal nutrition for their babies.
6 c No promotion material or group discussions on artificial milk are given/held in accordance with the International Code on marketing of breast milk substitutes (see page ).
6 d Mothers who decide not to breastfeed or are unable to breastfeed or only able to breastfeed partly are offered individual counseling about preparation of artificial milk and appropriate feeding strategy, and support of their decision/use of feeding method.
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