Breastfeeding Promotion in NICU Z. Mosayebi Neonatologist, Tehran University of Medical Sciences

Breastfeeding in NICU Breastmilk provides the best nutrition for growth and development of all newborns, whether they are full term, preterm, healthy or ill. Breastmilk is the best food for all infants in the NICU. It is associated with lower incidence of short term (sepsis, nosocomial infections, NEC, ROP,length of stay and readmission after discharge) and long term morbidities .

Barriers to Breastfeeding in NICU Breastfeeding challenges are stronger and even more numerous for high risk neonates. These babies having an even greater need for human milk. Breastfeeding initiation and duration encounter obstacles for hospitalized newborns in the NICU. Promote cue based and co-regulated feeding:

Barriers to Breastfeeding in NICU Mother - Stress and anxiety - Seperation - Motherhood - Sophisticated equipments - Pumping - Maternal health -provides a feeding readiness cue-assists transition to breast and bottle feeding

Barriers to Breastfeeding in NICU Neonates - Medically unstable - Developmental immaturity -provides a feeding readiness cue-assists transition to breast and bottle feeding

Barriers to Breastfeeding in NICU Environment - Lack of quiet home like env. - Lack of privacy - Lack of nursing staff support - Lack of medical team support - Lack of pumping space -provides a feeding readiness cue-assists transition to breast and bottle feeding

Baby Friendly 10 Steps 1. Have a written breastfeeding policy that us routinely communicated to all health care staff. 2. Train all healthcare staff in skills necessary to implement this policy. 3. Inform all pregnant women about the benefits and management of breastfeeding. 4. Help mothers initiate breastfeeding within one hour of birth. 5. Show mothers how to breastfeed and how to maintain lactation, even if they are separated from their infants. 6. Give newborn infants no food or drink other than breastmilk, unless medically indicated. 7. Practice “rooming-in” – allow mothers and infants to remain together 24 hours a day. 8. Encourage breastfeeding on demand. 9. Give no pacifiers or artificial nipples to breastfeeding infants. 10. Foster the establishment of breastfeeding support groups d refer mothers to them on discharge from the hospital or clinic. The Baby Friendly Hospital Initiative (BFHI) is an international program of the World Health Organization (WHO) and UNICEF. The initiative celebrates hospitals that have put in place policies and practices that enable parents to make informed choices about how to feed their babies. This initiative does not mean that all mothers must breastfeed but the 10 steps provides a guide so that hospitals are creating an environment of support for all mothers and help them make an informed choice on how to feed their babies. Read step #1: Mention that all staff need to know what the policy says and it should be displayed if at all possible for others to see it. Read #2: There are requirements of a set number of hours that the staff will need on breastfeeding. All staff that take care of the mother and baby should receive this training. Read #3: Mention that breastfeeding classes are important but that all staff need to make sure they are mentioning the benefits of breastfeeding to all pregnant mothers. Read #4: Mother should be assisted by staff to initiate breastfeeding as soon as possible. This is important for C- section mothers as well. Read #5: If a mother is separated from her infant she should receive a breast pump and instructed on the use within the first few hours of delivery.

Best Practice Guidelines for Supporting Breastfeeding in the NICU Breastfeeding promotion in the NICUs faces a unique set of challenges. Several strategies have been employed to try to counter the inherent challenges of breastfeeding in the NICU. Ten P’s for Practice

1. Policy A written policy is developed by a multidisciplinary team and communicated to all NICU personnel and families.

2. Personnel Education All personnel involved in the care of NICU babies receive comprehensive ongoing training and evaluation of basic competencies and skills necessary to implement the policy.

3. Parent Education Health care professionals encourage and inform mothers of NICU babies and their support networks about the benefits and management of breastfeeding.

4. Protect Milk Supply Breastfeeding or milk expression is initiated early and is done frequently and consistently with easy access to efficient breast pumps.

5. Plan An individulalized written feeding plan is developed that begins at admission and continues until baby transitions to effective feeding at the breast.

6. Priority Human milk is the primary source of nutrition for all NICU infants.

7. Parent Power Mother and family are empowered to be involved in baby’s care and feeding through close and frequent contact througout the hospital stay.

8. Practice Mother and baby are given the opportunity and encouragement for frequent practice at the breast prior to discharge home.

9. Postdischarge Outpatient support is provided post discharge for assisting mother in reaching her breastfeeding goals.

10. Progress Breastfeeding outcome goals are established regularly monitored and evaluated. A plan to meet these goals is developed and implemented by a multidisciplinary team.

“Promote, Protect, and Support breastfeeding as a vital part of health and development of neonates, their families and the community”.