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Indian Pediatr 2019;56:
1051-1052 |
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Providing Expressed Breast Milk to Preterm Neonates Admitted
in an Extramural Neonatal Intensive Care Unit: Where do we
stand?
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Dipti Kapoor *
and Mamta Jajoo
From Department of Pediatrics, Chacha Nehru Bal
Chikitsalaya, Geeta Colony, New Delhi, India.
Email:
[email protected]
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Provision of expressed breast milk
(EBM) to premature neonates poses a great challenge in extramural
Neonatal Intensive Care Units (NICUs). We conducted a
questionnaire-based survey to identify the various challenges faced by
the parents to provide EBM to their hospitalized premature infant. 40
preterm neonates (<34 wk gestation and <1500 g weight) planned to be
started on EBM were included in the study. The median (range) duration
after which EBM was received in NICU after the time it was asked for was
34.5 (13 to 40) hours, and it was received in a clean, sterile and
covered container in only 8 (20%) cases. There were multiple hurdles in
ensuring early availability of EBM in optimal condition. Sensitization
and motivation of families regarding the importance of ensuring early
administration of EBM to their prematurely delivered neonate may lead to
substantial improvement in outcome of these neonates.
Keywords: Exclusive breastfeeding, Feeding,
Nutrition.
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T
he benefits of breast milk for preterm neonates
are well known. Human milk provides protection to this highly vulnerable
population against late-onset sepsis [1], necrotizing enterocolitis [2],
retinopathy of prematurity [3] and re-hospitalizations in the first year
of life [4]. Preterm infants who received breast milk early in life have
improved neurodevelopmental outcomes [5,6]. In addition, premature
infants who receive human milk have lower rates of metabolic syndrome,
lower blood pressure and low-density lipoprotein levels, and less
insulin and leptin resistance when they reach adolescence, as compared
to premature infants receiving formula [7,8]. Various studies have shown
the benefits of early (within 48 h) administration of expressed breast
milk (colostrum) to preterm neonates. To accomplish this, expression of
breast milk should be initiated within 1 hour of delivery and continued
8-12 times per day until the milk supply is well established [9]. This
poses a challenge, especially in extramural neonatal units where mothers
are often away from neonates.
This study was conducted in an extramural level III
Neonatal Intensive Care Unit (NICU) of a tertiary care hospital, which
receives out-born preterm neonates from far off areas of Delhi and
neighbouring states. In most cases of preterm delivery, mothers are
admitted for post-partum care or are at home for initial few days after
delivery, and then the responsibility of bringing the Expressed Breast
Milk (EBM) from her to the admitted neonate falls on the father or other
caretakers. We conducted this questionnaire-based survey to determine
the duration after admission at which an admitted very low birth weight
preterm neonate receives EBM, the various reasons for delay in receiving
EBM, and the condition of EBM at receipt. The approval for the study was
obtained from Institute’s Scientific and Ethical Committee. Forty
preterm neonates (<34 wk gestation and <1500 g weight) planned to be
started on EBM were included in the study. The fathers or caretakers of
the neonates were sensitized about the importance of ensuring early
availability of EBM for their neonates and the appropriate conditions of
storage and transportation of EBM, by the staff nurse and resident
doctor on duty. The questionnaire was administered to the fathers or
caretakers at the time they were asked to bring EBM from the mother and
once again when EBM was received in NICU.
The mean (SD) gestation of neonates was 32 (1.8)
weeks and the mean (SD) weight was 1840 (250) g. The mean (SD) age at
starting EBM in these neonates was 22 (7.5) hours. Twenty (50%) of the
fathers were educated beyond 10 th
standard, 12 (30%) were educated till 8th
standard and rest 8 (20%) were illiterate. 16 (40%) of fathers were
skilled labourers, 15 (37.5%) were daily wagers and 9 (22.5%) were
self-employed. 28 (70%) of the fathers used public mode of transport
while only 12 (30%) used their own conveyance. The median (range)
distance from the hospital to their homes was 30.5 (7.5 to 60) km.
Thirty (75%) mothers were still admitted in another hospital (20 mothers
were post-caesarean section and 10 mothers had developed post-partum
complications after vaginal delivery). The remaining 10 (25%) were at
home. The median (range) duration after which EBM was received in NICU
after the time it was asked for, was 34.5 (13 to 40) hours. The various
reasons for delay as mentioned by the fathers were (some of the fathers/
caretakers cited more than one reason): unclear instructions (20%),
importance of EBM and method of expression not properly explained (40%),
long distance of hospital from home/center where mother was admitted
(62.5%), lack of self-conveyance (80%), cost of transportation (50%),
mother not motivated or unable to express breast milk (45%), mothers
suffering from lactational problems like engorged breast, inverted
nipple (30%), and religious taboos (27.5%). The EBM was received in a
clean, sterile and covered container in only 8 (20%) of the cases.
The limitations of our study were that though the
fathers and caretakers were sensitized regarding the importance of early
administration of EBM to their neonate and method of safe transportation
of EBM, their understanding was not assessed. Also, we could not ensure
whether the mothers admitted at some other hospital were counselled and
offered assistance in expression of breast milk.
This study highlights that ensuring the availability
of EBM in optimal condition to the neonates admitted in extramural
centres remains a challenge in our country. Certain interventions like
education and motivation of families regarding the importance of EBM in
preterm survival soon after delivery, assisting mothers in early
expression of breast milk and sensitization of fathers and caretakers
regarding appropriate transport conditions of EBM may result in better
and early availability of EBM for preterm infants admitted in extramural
NICUs.
Acknowledgement: Dr Bentu Kalyan, Department of
Pediatrics, Chacha Nehru Bal Chikitsalaya for help in collection of data
and counselling of fathers and caretakers.
Funding: None; Competing interest; None
stated.
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