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Discharge Planning. Discharge planning should be initiated upon admission with an assessment of mother's breastfeeding goals and preferences. If a rooming-in suite is available and parents are amenable, a 1-2
night stay can point out problems and maximize learning. In the week prior to discharge an individualized home discharge nutritional and transition to full breastfeeding plan should be prepared in coordination with the neonatologist, lactation consultant, dietitian, and family, and the plan reviewed with the post-discharge primary physician before discharge. The plan should be based on the skills of the infant, the mother's milk production, and the infant's nutritional needs. It is also important to refer the mother/family to community nutritional and breastfeeding support resources.
Follow-up. Routine primary care follow-up should be arranged as needed. Lactation follow-up should be scheduled for 2-3 days post discharge and thereafter as needed until full direct breastfeeding achieved, or mother ceases breastfeeding. A repeat biochemical assessment is recommended at 1 month post-discharge (Hall, 2001). Some authors suggest repeat biochemical assessments approximately every 2 months until at least 1 year corrected age. Follow-up should also be arranged with the dietician as needed to adjust caloric, protein and other nutrient intake.
Conclusion. There is much we don't know about the optimal growth rates and nutrition for the premature infant after discharge. The average corrected age of preterm infants at discharge is 35-36 weeks and weight is 1800-2000 gm, but infants vary enormously in age, weight, medical condition and nutritional needs. In many parts of the world, preterm infants are discharged much heavier and older than in the USA and have therefore had much more opportunity to mature and learn to breastfeed. Mothers should be encouraged to spend as much ime as possible with their infants in the NICU and supported in their efforts to establish and maintain a full milk supply. Kangaroo care, non-nutritive breastfeeding and earlier direct breastfeeding in the NICU, along with a full milk supply will help mothers continue to provide "liquid gold" for their growing infants long after discharge from the NICU (Furman 2002).
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References:
Furman L, Minich N, Hack M. (2002) Correlates of Lactation in Mothers of Very Low Birth Weight Infants. Pediatrics. 109(4):e57 www.pediatrics.org/cgi/content/full/109/4/e57
Griffin IJ. (2002) Postdischarge nutrition for high risk neonates. Clin Perinatol. 29:327-344
Hall RT. (2001) Nutritional Follow-Up of the Breastfeeding Premature Infant After Hospital Discharge. Ped Clin NA. 48(2):453-460
Hall RT, Carroll RE. (2000) Infant Feeding. Ped in Review. 21(6):191-200
NM, Meier PP, Engstrom JL, et al. (1999) Mothers performing in-home measurement of milk intake during breastfeeding for their preterm infants: Effects on breastfeeding outcomes at 1, 2, and 4 weeks post-NICU discharge. Pediatr Res. (abstr ) 45: 125A
Marinelli K. (2001) A Comparison of the Safety of Cupfeedings and Bottlefeedings in Premature Infants Whose Mothers Intend to Breastfeed. J. Perinatol 21:350-355
Meier PP. (2003) Supporting Lactation in Mothers with Very Low Birth Weight Infants. Pediatric Annals. 32(5):317-325
Meier PP, Engstrom JL, Crichton CL, et al. (1994) A New Scale for In-Home Test-Weighing for Mothers of Preterm and High Risk Infants. J Hum Lact. 10:163-68
Scanlon KS, Alexander MP, Serdula MK at al. (2002) Assessment of Infant Feeding: The Validity of Measuring Milk Intake. Nutrition Reviews. 60(8):235-251
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