Letters to the Editor

Indian Pediatrics 2002; 39:983-984

Relactation in Mothers of High-Risk Infants

We read with interest the study on relactation(1). Pediatricians around the country need to be convinced all over again about the rewards of breastfeeding and that relactation is possible even in the most unlikely of settings. We would like to share our experience of successful relactation in high-risk babies.

Case-1: A 34-day-old baby, born at 28 weeks gestation with birth weight 700 grams, had been managed at a local hospital with incubator care, parenteral fluids, antibiotics and formula feeds and had experienced no serious perinatal problems. She had received no breastmilk at all. Expression of breastmilk was never attempted in the mother. On admission, she weighed 720 gms, was active, systems were normal, there were no external congenital anomalies. Sepsis screen done was negative. Baby-breast contact was initiated and the mother was taught manual expression of breastmilk. Every 2 hours she was made first to suckle the baby and then to express breastmilk. Needless to say, she was encouraged and reassured at every step. The baby was discharged after 3 weeks, having shown steady weight gain, on exclusive breastfeeds. She is now 8 months old, weighs 6 kg; her milestones are appropriate for postconceptional age.

Case-2: A 45-day-old term baby with Pierre-Robin syndrome was admitted with pneumonia and failure to thrive. She had been on formula feeds given with bottle, since birth. The mother was apprehensive, but with support and encouragement, partial relactation was achieved and sustained throughout the first year of life. Early weaning was done with rice-based feeds. She showed good catch-up growth. Cleft-palate repair was done at age 1 year. She is thriving well.

Case-3: A 2-week-old term baby, of birth weight 2.1 kg, with Pierre-Robin syndrome, was referred to us with feeding problems and loss of weight. She had been on formula feeds through nasogastric tube. Expressed breastmilk (EBM) had never been given. She weighed 1.58 kg. The mother was taught how to express breastmilk and within 4 days was secreting sufficient milk. EBM feeds were initiated through nasogastric tube; as the mother gained confidence, ‘gokarnam’ feeds were started. Regular baby-breast contact and direct breastfeeding with the baby held erect in the mother’s lap were encouraged; by the age of 4 weeks, the baby was sucking well, without aspiration of feeds. Complete relactation was achieved and sustained to date.

These cases illustrate that effective relactation is possible and beneficial, even in high-risk infants, provided that the mother gets continued support and encouragement from the attending pediatrician.

References

1. De NC, Pandit B, Mishra SK, Pappu K, Chaudhuri SN. Initiating the process of relactation: an Institute based study. Indian Pediatr 2002, 39: 173-178.