The 3 M's of Breast-feeding the Preterm Infant

Hurst, Nancy

doi:10.1097/01.jpn.0000285813.59269.6e

Cited by 8 publications

(4 citation statements)

References 24 publications

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“…Premature babies benefit from breast milk nutritionally, immunologically and developmentally [ 35 ]. The short-term and long-term benefits compared with formula feeding are well established with lower incidence of infection and necrotising enterocolitis and improved neuro-developmental outcome [ 36 , 37 ]. Most premature babies require extra support for feeding with a cup, spoon or another device such as gastric tubes (either oral or nasal) [ 38 , 39 ].…”

Section: Package 1: Essential and Extra Newborn Carementioning

confidence: 99%

Born Too Soon: Care for the preterm baby

Davidge²,

et al. 2013

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As part of a supplement entitled "Born Too Soon", this paper focuses on care of the preterm newborn. An estimated 15 million babies are born preterm, and the survival gap between those born in high and low income countries is widening, with one million deaths a year due to direct complications of preterm birth, and around one million more where preterm birth is a risk factor, especially amongst those who are also growth restricted. Most premature babies (>80%) are between 32 and 37 weeks of gestation, and many die needlessly for lack of simple care. We outline a series of packages of care that build on essential care for every newborn comprising support for immediate and exclusive breastfeeding, thermal care, and hygienic cord and skin care. For babies who do not breathe at birth, rapid neonatal resuscitation is crucial. Extra care for small babies, including Kangaroo Mother Care, and feeding support, can halve mortality in babies weighing <2000 g. Case management of newborns with signs of infection, safe oxygen management and supportive care for those with respiratory complications, and care for those with significant jaundice are all critical, and are especially dependent on competent nursing care. Neonatal intensive care units in high income settings are de-intensifying care, for example increasing use of continuous positive airway pressure (CPAP) and this makes comprehensive preterm care more transferable. For health systems in low and middle income settings with increasing facility births, district hospitals are the key frontier for improving obstetric and neonatal care, and some large scale programmes now include specific newborn care strategies. However there are still around 50 million births outside facilities, hence home visits for mothers and newborns, as well as women's groups are crucial for reaching these families, often the poorest. A fundamental challenge is improving programmatic tracking data for coverage and quality, and measuring disability-free survival. The power of parent's voices has been important in high-income countries in bringing attention to preterm newborns, but is still missing from the most affected countries.DeclarationThis article is part of a supplement jointly funded by Save the Children's Saving Newborn Lives programme through a grant from The Bill & Melinda Gates Foundation and March of Dimes Foundation and published in collaboration with the Partnership for Maternal, Newborn and Child Health and the World Health Organization (WHO). The original article was published in PDF format in the WHO Report "Born Too Soon: the global action report on preterm birth" (ISBN 978 92 4 150343 30), which involved collaboration from more than 50 organizations. The article has been reformatted for journal publication and has undergone peer review according to Reproductive Health's standard process for supplements and may feature some variations in content when compared to the original report. This co-publication makes the article available to the community in a full-text format.

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Section: Package 1: Essential and Extra Newborn Carementioning

confidence: 99%

Born Too Soon: Care for the preterm baby

Davidge²,

et al. 2013

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“…Enteral feeding practices among preterm infants admitted to NICUs varies in type of milk, route of feeding, frequency of feeding and rates of advancement [12]. The process of feeding the preterm infant with breast milk is generally divided into three phases: initiation, maintenance (breast milk feeding) and transition to breast feeding at or before discharge from hospital [13]. Each of these three phases can be affected by: prematurity, separation between infant and mother, the health of the mother following childbirth, multiple pregnancies and the infant's clinical course.…”

Section: Discussionmentioning

confidence: 99%

The Impact of Neonatal Service ReOrganisation on Feeding of Preterm Infants (<34 Weeks): A Prospective Cohort Study in a Regional Neonatal Unit from 1992 to 2010

Akuma¹,

Jordan²,

Watkins³

2018

J Nurs Health Stud

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Objectives: To describe Neonatal Intensive Care Unit (NICU) feeding practices during the neonatal period and explore predictors of any breast milk feeding at discharge among very preterm infants admitted before and after re-organisation of neonatal services in a region of the UK. Methods: Data on feeding of preterm infants (<34+0 weeks) at four time-points in the neonatal period and at discharge were collected prospectively on 1018 infants admitted to a regional NICU over a 19-year period. These data were subjected to unadjusted and adjusted analyses and time trends calculated before and after the transition. Results: Initiation of breast milk feeding in preterm infants increased throughout the study. However, the proportion of infants receiving breast milk declined steadily through the neonatal period and beyond. Before re-organisation, breast milk feeding (any) at discharge increased year-by-year (slope coefficient for trend 0.127, p<0.001). After re-organisation, the trend slowed down/decelerated (slope coefficient for trend 0.071, p 0.32). Any breast milk feeding at day 7 of life, singleton pregnancy, and length of hospital stay were associated with any breast milk feeding at discharge. Conclusions: Breast milk feeding of preterm infants increased in line with secular trends. However, this trend fell away following neonatal service reorganisation. This finding suggests that service providers and commissioners should monitor infant feeding trends in NICUs against national trends, as a benchmark of maternal and infant wellbeing and service delivery. The early predictors of any breast milk feeding at discharge found in this study need further research to validate their usefulness.

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“…According to some authors, Se + /Le + phenotype results protective against some infections, such as E. coli and Campylobacter spp. and preventive of NEC ( 35 ), while infants fed with BM from Se − mothers would show a higher risk for diarrheal diseases ( 11 , 39 , 40 ).…”

Section: Metabolomicsmentioning

confidence: 99%

“…Since the degree of prematurity highly influences BM features, the resulting composition is optimal for preterm newborns needs. Macro- and micronutrients levels vary and determine advantages regarding immunity, neurological development, gastrointestinal maturation ( 9 , 11 – 17 ).…”

Section: Introductionmentioning

confidence: 99%

Human Breast Milk: Exploring the Linking Ring Among Emerging Components

et al. 2018

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Maternal breast milk (BM) is a complex and unique fluid that evolution adapted to satisfy neonatal needs; in addition to classical nutrients, it contains several bioactive components. BM characteristically shows inter-individual variability, modifying its composition during different phases of lactation. BM composition, determining important consequences on neonatal gut colonization, influences both short and long-term development. Maternal milk can also shape neonatal microbiota, through its glycobiome rich in Lactobacilli spp. and Bifidobacteria spp. Therefore, neonatal nourishment during the first months of life seems the most important determinant of individual's outcomes. Our manuscript aims to provide new evidence in the characterization of BM metabolome and microbiome, and its comparison to formula milk, allowing the evaluation of each nutrient's influence on neonatal metabolism. This result very interesting since potentially offers an innovative approach to investigate the complex relationship between BM components and infant's health, also providing the chance to intervene in a sartorial way on diet composition, according to the nutritional requests. Future research, integrating metabolomics, microbiomics and stem cells knowledge, could make significant steps forward in understanding BM extraordinary properties and functions.

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The 3 M's of Breast-feeding the Preterm Infant

Cited by 8 publications

References 24 publications

Born Too Soon: Care for the preterm baby

Born Too Soon: Care for the preterm baby

The Impact of Neonatal Service ReOrganisation on Feeding of Preterm Infants (<34 Weeks): A Prospective Cohort Study in a Regional Neonatal Unit from 1992 to 2010

Human Breast Milk: Exploring the Linking Ring Among Emerging Components

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