Research indicates that preterm and ill infants greatly benefit, and will be able to go home sooner by receiving their mothers' milk. ^1,10 In addition, pumping and providing milk for their babies contributes to the physical and emotional recovery of the mother. ¹¹ Unfortunately, many of these mothers are a high risk for delayed lactogenesis and/or low milk supply. Some risk factors for delayed lactogenesis II (later than 72 hours postpartum) and for low milk supply are outlined in Tables 2 and 3 below.

How can we help these mothers be successful in providing the "gift" that only they can give to their babies? Research and experience provide some best practices that we can encourage. ¹³

1. Early initiation of pumping (within the first 6-12 hrs post-delivery).
2. Pumping 8 times in 24 hrs using a hospital-grade pump.
3. Breast massage and manual expression prior to pumping to facilitate the letdown reflex.
4. Pump at the infant's bedside for sensory letdown cues.
5. Use even the smallest amount of milk produced for early trophic feeds to encourage mother to produce more to help her baby.
6. Kangaroo care (skin-to-skin care) stimulates milk production, let-down and increases duration of breastfeeding post-discharge.
7. Non-nutritive tasting at the breast ("dry" breastfeeding) stimulates milk production and lengthens time of breastfeeding post-discharge.
8. Using galactogogues (eg. Fenugreek or Reglan) after evaluation by a lactation consultant when milk supply declines.
9. Keeping a record of milk production.

We can provide consistent evidence-based information and support for our patient's families so that mothers recognize the truly unique value of their milk for their infants, are successful at establishing and maintaining their milk supply, and get to successfully breastfeed their infants. For more specific information and references, see the "Improving Nutrition for the VLBW Infant" toolkits at www.cpqcc.org.

References

1. American Academy of Pediatrics. Section on Breastfeeding. Breastfeeding and The Use of Human Milk. Pediatrics 2005; 115(2): 496-506.
2. Schanler, R.J. The use of human milk for premature infants. Pediatric Clinics of North America 2001; 48(1), 207-220.
3. Hanson, L.A. Immunobiology of human milk: How breastfeeding protects babies. Pharmasoft Publishing: Amarillo, 2004.
4. Neville, M.C., Morton, J., & Umemura, S. Lactogenesis: The transition from pregnancy to lactation. Pediatric Clinics of North America 2001; 48(1), 35-52.
5. Henderson, J.J., Simmer, K., Newnham, J.P., Doherty, D.A., & Hartmann, P.E. (September, 2004). Impact of very preterm delivery on the timing of lactogenesis II in women. Poster # 34, 12th International Conference of the International Society for Research in Human Milk and Lactation. Queen's College, Cambridge.
6. Furman, L., Minich, N., & Hack, M. Correlates of lactation in mothers of very low birth weight infants. Pediatrics 2002 109(4), e57, www.pediatrics.org/cgi/content/full/109/4/e57.
7. Smith, M.M., Durkin, M., Hinton, V.J., Bellinger, D., & Kuhn, L. Initiation of breastfeeding among mothers of very low birth weight infants. Pediatrics 2003; 111, 1337-1342.
8. Wooldridge, J., & Hall, W.A. Posthospitalization breastfeeding patterns of moderately preterm infants. Journal of Perinatal Neonatal Nursing 2003; 17(1), 50-64.
9. Cox, D.B. et al. Breast growth and the urinary excretion of lactose during human pregnancy and early lactation: endocrine relationships. Exp Physiology 1999; 84, 421-434.
10. Schanler RJ, Shulman RJ, Lau C. Feeding strategies for Preterm infants: beneficial outcomes for feeding fortified milk versus Preterm formula. Pediatrics 1999; 103(6): 1150-1157.
11. Kavanaugh KL et al. The rewards outweigh the efforts: breastfeeding outcomes for mothers of Preterm infants. J Hum Lact 1997; 13: 15-21.
12. Powers N. Chapter 10: Low Intake in the Breastfed Infant: Maternal and Infant Considerations, in Riordan J, ed. Breastfeeding and Human Lactation, 3rd Ed, Jones and Bartlett, Boston, 2005.
13. California Perinatal Quality Care Collaborative, Perinatal Quality Improvement Panel, Nutritional Support of the VLBW Infant, Part 1 (2004) & Part 2 (2005), www.cpqcc.org.