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Neonatal ICU for premature babies

Enhanced staff contact for breastfeeding mothers of low birth weight infants is cost effective. This study evaluated the cost-effectiveness of enhanced staff contact for mothers with infants in a neonatal unit with a birth weight of g There is evidence that breastmilk feeding reduces mortality and short and long-term morbidity among infants born too soon or too small.

Background

The study population was divided into three groups by weight: g, 1kg The measure of benefit was quality-adjusted life-years. The researchers found that the intervention was less costly and more effective than the comparator for each birth weight group. They acknowledge that whilst the results provide preliminary indications that enhanced staff contact may be cost-effective, this is the first economic evaluation in this complex field and further work is indicated.

Their findings offer a model to be developed in future research. Rice SJ, Craig D, McCormick F et al Economic evaluation of enhanced staff contact for the promotion of breastfeeding for low birth weight infants. It is known that when babies are born preterm or are sick, the use of breastmilk substitutes is associated with increased adverse outcomes both in the short and long term. A major systematic review and economic analysis has been conducted to evaluate the effectiveness and cost-effectiveness of interventions that promote or inhibit breastfeeding or feeding with breastmilk for infants admitted to neonatal units.

The authors found that kangaroo skin-to-skin contact, peer support, simultaneous breast milk pumping, multidisciplinary staff training and the Baby Friendly accreditation of the maternity unit have been shown to be effective, whilst skilled support from trained staff in hospital has been shown to be potentially cost-effective. They conclude that many of these interventions inter-relate and are unlikely to be effective if used alone, particularly in the absence of staff training or where the environment is not encouraging and supportive to breastfeeding and expressing breastmilk and where mothers are not afforded close contact with their infants.

In Baby Friendly accredited units the numbers of infants receiving any breastmilk in the first week of enteral feeds, and the duration of any or exclusive breastfeeding, are significantly increased. Renfrew M, Craig D, Dyson L et al Breastfeeding promotion for infants in neonatal units: a systematic review and economic analysis. Health Technol Assess 13 Moderately preterm infants weeks account for a large proportion of admissions and bed-days in neonatal units.

A large study 2, infants of the postmenstrual age PMA at hospital discharge and its relationship to perinatal risk factors and to organisation of care was carried out in Sweden. The researchers found that average PMA at discharge was High 35 years maternal age, multiple birth, small for gestational age, respiratory distress syndrome, infection, hypoglycaemia and hyperbilirubinaemia were significantly associated with higher PMA at discharge, but could only explain 13 per cent of the differences.

Breastfed infants had lower PMA at discharge mean 2. Fetal Neonatal Ed; FF Therefore, parents, caregivers and health-care professionals may treat late-preterm infants as though they are developmentally more mature than they are. This paper identifies the increasing incidence of babies born at this gestation and proposes management plans for their care.

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Pediatrics; 6 : A review of the current evidence regarding the feeding of low birth weight infants i. Edmond K, Bahl R Optimal feeding of low-birth-weight infants: technical review. It is recognised that the health of preterm babies benefits greatly from the ingestion of their mothers own breastmilk due to a number of factors including the presence of active enzymes that enhance the maturation of the underdeveloped gut, anti-infective properties which protect the newborn from infection and earlier tolerance of full enteral feeding. The aim of this systematic review, therefore, was to compare the effects of pasteurised donor breast milk and infant formula in preterm infants.

Seven studies were found to comply with the inclusion criteria, although methodological weaknesses were present in all. The other main outcome measure of growth had mixed findings with more studies finding in favour of formula in terms of infant growth.

My NICU Baby™ App Supports Parents of Babies Born Sick or Too Soon

One study however, tracked growth at 9 and 18 months and years at which times no significant differences in a range of growth measurements were found. Importantly, this study found significantly slower growth in the donor milk group compared with the formula group during the early postnatal period.

In response to the Boyd paper above Williams et al make a number of useful comments in a perspective published in the same journal. Randomised diet in the neonatal period and growth performance until 7.

Am J Clin Nutr ;—8. Boyd C. Archives of Disease in Childhood; FF Williams A. Archives of Disease in Childhood; F Neonatal Care Research. Below is a selection of recent research on the effects of breastfeeding and breastmilk on neonatal outcomes. For more information on embedding Baby Friendly care in the neonatal unit, see our dedicated guidance document.

Breastfeeding promotion for infants in neonatal units It is known that when babies are born preterm or are sick, the use of breastmilk substitutes is associated with increased adverse outcomes both in the short and long term. Health Technol Assess 13 40 Breastfeeding may help earlier discharge for preterm infants Moderately preterm infants weeks account for a large proportion of admissions and bed-days in neonatal units. Pediatrics; 6 : WHO review of optimal feeding of low-birth-weight infants A review of the current evidence regarding the feeding of low birth weight infants i.

Where this is unavailable, donor human milk would be the next best choice. The timing of the introduction of solid diet should generally equate with that for babies born at term. Expressed breast milk should be offered by cup rather than bottle as this leads to higher rates of exclusive breastfeeding at discharge from hospital. Non- nutritive sucking has some benefits in terms of reduced hospital stay. Use of medications such as domperidone may help improve milk supply. WHO Donor breastmilk versus infant formula for preterm infants It is recognised that the health of preterm babies benefits greatly from the ingestion of their mothers own breastmilk due to a number of factors including the presence of active enzymes that enhance the maturation of the underdeveloped gut, anti-infective properties which protect the newborn from infection and earlier tolerance of full enteral feeding.

Given the incidence of preterm birth, the paucity of data in this area is disappointing. Many times it feels that there are very few things you can do for your baby while in the NICU. Kangaroo care can be an opportunity for mothers and fathers to do something positive for their precious newborn. Kangaroo care is a great time to talk softly, sing or hum quietly to your baby, or sit quietly and be grateful for the small things.

This is a precious moment and that hour will fly by. Before you know it you will be asking when can I do it again? Maternal holding of preterm infants during the early weeks after birth and dyad interaction at six months. Kangaroo mother care: a practical guide. Journal of Neonatal Nursing, 19, Kangaroo care in pre-term or low birth weight babies in a postnatal ward.


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British Journal of Midwifery, 19, 9, Provision of Kangaroo Mother Care: supportive factors and barriers perceived by parents. Caring Sciences, 27, Clinical Protocol Number Non-pharmacologic management of procedure-related pain in the breastfeeding infant. Breastfeeding Medicine 5 6 , DOI: United States Institute for Kangaroo Care. Briefly, Our Son and Daughter-in-law had Audrey via c-section 2 months early to her due date.

She has been in the NICU 33 days and doing well learning to eat. She is beautiful and a miracle. For us and me especially this has been an awful time. The kids have been extremely cold and not personable with us at all. We never saw Audrey and not one photo, video or moment was shared with us. This is our first Grandbaby!! I told my husband the day she was born how I felt he defended Brian and said I was negative so I said I would not share my feelings. I saw her for the 1st time 2 days ago. It was ok.


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We were there 45 minutes. This is putting a strain on my marriage. I have no one to talk to about how this has affected me. Who can I turn to for help? Any resources or ideas would be helpful. Thank you. Debbie Blum Hi Debbie! First, congratulations on the birth of your first grandchild!

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It sounds like this has been a difficult time for your family. Please understand that your son and daughter-in-law are likely under a tremendous amount of stress and dealing with a lot of fear and uncertainty while their child is in the NICU. The NICU is an emotional rollercoaster for everyone — even grandparents — for different reasons. The best thing you can do for your son and his wife is to be a source of comfort and support and realize that they may not be in the position to provide that same comfort and support to you at this time.

Getting counseling for yourself sounds like a great way for you to be proactive about processing your feelings. Support groups are a great way to connect with other NICU families. Your email address will not be published. Notify me of followup comments via e-mail.