Our new NICU policy–>Breastmilk IS our babies food!

Yes! This HAS been accepted!!!

Here is an excerpt from our NEW NICU policy:

Policy Statement: It is the policy of the NICU to provide all mothers with factual information regarding the superior nutritional, immunological and therapeutic beneficial effects that human milk and breastfeeding will have on the health outcomes of their preterm or sick newborn so that their feeding decision will be evidence based. The healthcare professional has an ethical responsibility to avoid withholding information because of any unfounded concerns that informing mothers of research-based options may make them feel guilty if they choose not to breastfeed. The mother’s informed decisions will be totally supported and her infant will be provided nourishment in accordance with her decisions.  All mothers should be considered breastfeeding candidates until they specify intent to bottle feed.

Purpose: To promote and support human milk as the preferred method of providing nutrition. Provide assistance to the mother in establishing and maintaining breastfeeding.

Policy:

1. Any mother desiring to breastfeed or provide breastmilk for her baby will be given consistent current and correct evidence-based information, emotional support and encouragement she may need to reach her individual goals. Healthcare professionals will avoid conveying information based on any personal breastfeeding experience as it may not be appropriate or applicable in discussions with mothers.
2. Mothers may be asked/encouraged to temporarily pump/express and provide colostrum for their infant’s immediate protection and health needs regardless of their feeding choice.
3. The mother will be involved in all feeding plans as soon as possible.
4. All NICU infants will be fed according to their nutritional requirements as ordered by the physician.
5. Early trophic feedings of colostrum/milk to stimulate intestinal maturity will be utilized as ordered and when there is colostrum available. It is beneficial for infant to wait a day or two until colostrum is available to maximize the transfer of protective components. Colostrum should be given to infant in the order it was pumped.
6. Oral care/ mouth swabbing will be done using colostrum/ breastmilk.
7. A multidisciplinary approach involving the physician, NICU team, the mother and a lactation professional to develop an individualized feeding plan will be utilized as soon as feasible in accordance with each infants requirements and feeding abilities.
8. Cue-based feedings will be encouraged and utilized as soon as possible. All mothers will be provided educational information and encouraged to understand and participate in reading their infant’s feeding cues.
9. Kangaroo care and/or skin-to-skin will be utilized and encouraged as much as possible..
10. Stable premature infants should be allowed to go to mother’s breast during gavage feedings to ready infant for transition to breastfeeding.

Etc etc etc……………………………….. much more……………..

The policy I submitted was written using Marsha Walker’s  “Breastfeeding Management for the Clinician. Using the Evidence” as a major guide. I think I even used her words a lot. (Seriously-who can say it better?)

YAY! Thank you to my team and thank you Marsha!

DUE TO REPEATED REQUESTS FOR THE WHOLE POLICY… HERE IS WHAT I HAVE… I HAVE INCLUDED THE REFERENCES

 

Policy  Statement:      It is the policy of the Special Care Nursery/NICU to provide all mothers with factual information regarding the superior nutritional, immunological and therapeutic beneficial effects that human milk and breastfeeding will have on the health outcomes of their preterm or sick newborn so that their feeding decision will be evidence based. The healthcare professional has an ethical responsibility to avoid withholding information because of any unfounded concerns that informing mothers of research-based options may make them feel guilty if they choose not to breastfeed. The mother’s informed decisions will be supported and her infant will be provided nourishment in accordance with her decisions.  All mothers should be considered breastfeeding candidates until they specify intent to bottle feed.

 

Purpose:         To promote and support human milk as the preferred method of providing nutrition. Provide assistance to the mother in establishing and maintaining breastfeeding for optimal growth and development.

 

Policy:

1. Any mother desiring to breastfeed or provide breastmilk for her baby will be given consistent current correct evidence-based information, emotional support and encouragement she may need to reach her individual goals. Healthcare professionals will avoid conveying information based on any personal breastfeeding experience as it may not be appropriate or applicable in discussions with mothers.
2. Mothers may be asked/encouraged to temporarily pump/express and provide colostrum for their infant’s immediate protection and health needs regardless of their feeding choice.
3. The mother should be involved in all feeding plans whenever possible.
4. All SCN/NICU Infants will be fed according to their nutritional requirements as ordered by the physician.
5. Early trophic feedings of colostrum/milk to stimulate intestinal maturity will be utilized as ordered and when there is colostrum available. It is beneficial for infant to wait a day or two until colostrum is available to maximize the transfer of protective components. Colostrum should be given to infant in the order it was pumped.
6. Oral care/ mouth swabbing will be done using colostrum/ breastmilk.
7. A multidisciplinary approach involving the physician, SCN/NICU team, the mother and a lactation professional to develop an individualized feeding plan will be utilized as soon as feasible in accordance with each infants requirements and feeding abilities.
8. Cue-based feedings will be encouraged and utilized as soon as possible. All mothers will be provided educational information and encouraged to understand and participate in reading their infant’s feeding cues.
9. Kangaroo care and/or skin-to-skin will be utilized and encouraged as much as possible..
10. Stable premature infants should be allowed to go to mother’s breast during gavage feedings to ready infant for transition to breastfeeding.
11. Promoting non-nutritive suckling at mother’s recently pumped/drained breast will be encouraged whenever applicable. Although pacifiers are not routinely used for healthy term breastfeeding infants, preterm infants in the Special Care Nursery/NICU or infants with specific medical conditions may be given pacifiers for non-nutritive sucking.
12. Feeding at the breast will be introduced as soon as possible for those sick or preterm infants as they improve and display appropriate feeding readiness cues.
13. Supplementation, complimentary feedings and use of alternative feeding devices including nipple shields will be individualized in accordance with the multidisciplinary feeding plan above. (#7)
14. Human milk fortifier may be indicated and will be added as ordered by the physician.
15. Breastfeeding Policy  #6250-OB-B-3 and Breastmilk Collection and Storage Policy #6250-OB-B-3A will apply wherever applicable.
16. If a mother is unavailable for feeding and/or has chosen to pump and store her breastmilk for infant feedings, she will be provided with written pumping instructions. These pumping practices to maximize early production and volume include:

1. Begin pumping within 6 hours after delivery whenever possible (as clinically indicated by infants and/or mothers medical condition). Early and frequent pumping in the first week is crucial.
2. Double pumping with high quality hospital grade pump (or pump which cycles 48-50 times/minute and with vacuums not exceeding 240mm Hg.)
3.  Simultaneous pumping with properly fitting flange and added breast massage yields more milk and higher fat content.
4. Pump at least 6 times in 24 hours (100 total minutes/day). Mothers pumping at least 8-12 times in 24 hrs yielded higher milk output.
5. Evaluate any mother’s concerns over low milk volume promptly to promote maximal adequacy of milk expression.
6. A mother may be encouraged to use the breast pump at the infant’s bedside as a means to increase milk production.
7. Collect milk in plastic tightly lidded containers (ie Snappies) which are self labeled by mother with infant’s name, date of birth, MR#, date and time milk was pumped.
8. Freshly expressed milk that can be immediately given to infant provides optimal protection factors.
9. Milk must be promptly stored in the refrigerator if it is to be used within the next 48 hours.  Breast milk may be placed in the freezer for 3 months or in a deep freeze for up to 6 months.  If the infant is preterm or a sick term infant, frozen breast milk should be used within 3 months, however, it is preferable to use outdated breast milk as opposed to artificial milk.
10. Mother should transport her milk to the hospital frozen in a cooler with an ice pack.  Thawed breast milk must be used in 24 hours.
11. If milk brought by the Mother is thawed, it must be placed in the refrigerator.  It cannot be refrozen.

 

 

References:

Bakewell-Sachs, S. and Brandes, A. (2003).  Nutritional Management. In Verklan, M.T. and Walden, M.  Core Curriculum for Neonatal Intensive Care Nursing, 3^rd Ed. St.Louis,MO: Elsevier Saunders.

Crosson, D.D and Pickler, R.H. (2004). An Integrated Review of the Literature on Demand Feedings for Preterm Infants.  Adv Neonatal Care. 4(4): 216–225.

Dougherty, D.  and Luther, M. (2008). Birth to Breast—A Feeding Care Map for the NICU: Helping the Extremely Low Birth Weight Infant Navigate the Course. Neonatal Network. (27) 6.  Pp 371-377

Kirk, A.T., Alder, S.C., King, J.D. (2007).  Cue-based oral feeding clinical pathway results in earlier attainment of full oral feeding in premature infants:  Cue-based oral feeding clinical pathway.  Journal of Perinatology (27) 572-578.

Meier PP, Engstrom JL, Patel AL, Jegier BJ, Bruns NE. Improving the use of human milk during and after the NICU stay. Clin Perinatol. 2010 Mar;37(1):217-45. Accessed via PubMed July 17 2010

Walker, Marsha (2011). Breastfeeding Management for the Clinician- Using the Evidence 2^nd ed. Jones and Bartlett, Sudbury MA