Breastfeeding the LBW in KMC

The main source of nutrition for the stable growing premature baby in KMC is the mother’s own breast milk. However, because of prematurity, the ability to suck, swallow and breathe in a coordinated fashion, may not yet be fully developed, especially if babies are born before 34 weeks gestation. So other methods and manner of feeding breast milk are listed below

  1. Methods of feeding breast milk
    1. Tube feeding – a small tube is inserted through the baby’s mouth to reach the stomach and breast milk is poured and allowed to flow through it.
    2. Dropper feeding- a dropper is used to give breast milk to the baby when she/he is able to swallow and breathe appropriately. (around 32 weeks) but too weak to sustain sucking
    3. Cup feeding – expressed breast milk is given by a cup that is placed on the lower lip and the baby’s tongue and upper lip, as it touches the  milk are able to coordinate the feeding.
    4. Direct breastfeeding – baby is latched-on directly to the breast for sucking. This method not only requires maturity (around 33-34 weeks) but also strength to sustain the “work” of breastfeeding. Some babies are old enough to breastfeed directly but because of their small size, can get tired and lose calories and lose weight in the process, instead of gaining weight. Other methods above may be used to assist the baby in feeding  (mixed methods) and enhancing weight gain.
  2. Breastfeeding positions – pictures will be shown
  3. Other sources of nutrition for babies weighing less than 1500 gm (1500gm, mother’s own breast milk has been proven sufficient to meet everything the baby needs for appropriate growth and development.
    1. Colostrum – the first, yellowish, thick breast milk “concentrate”, a mother is able to express from her breast during the first 7-10 days after delivery. This form of breast milk is very important for the trophic stimulation of the intestine and also stimulation of immunological protection and maturation, rather than nutritional source. It contains large amounts of antibodies and nutrients valuable for the premature infant’s survival  especially in the first week of life.
    2. Exclusive own mother’s milk – As stated above, this is sufficient to support weight gain in a baby weighing >1500gm. If the baby does not show adequate weight gain (15gm/kg/day) or growth (0.7cm/week), the mother’s “hind milk” is expressed and given as a supplement. Breastfeeding babies are able to suck the mother’s “foremilk” in the first 10-15 minutes of breastfeeding and later, the mother’s “hindmilk” which has a higher fat content. The premature/LBW baby who is directly breastfeeding may tire out and not be able to access the hind milk. In order to enhance caloric supply, the mother expresses the hind milk after the baby has breastfed and gives it by dropper or cup just before the next breastfeed.
    3. Fortified own mother’s milk – A commercially-available human milk fortifier containing proteins, carbohydrates, calcium, phosphate and sodium, may be added to mother’s own milk and given to premature/LBW babies who are not manifesting adequate weight gain and growth. Human milk fortifiers are not available in the Philippine market at this time. A KMC mother may ask her attending doctor regarding this matter for assistance.
    4. Supplemented own mother’s milk – If a mother is not available to breastfeed or was not able to leave enough breast milk for feeding while the baby is still in the hospital, fortified own mother’s milk or fortified donors’ milk may be given to the baby.
    5. Fortified donors’ milk – Human milk banks may be able to supply a premature/LBW babies’ needs from donors’ milk that has been collected, pasteurized and frozen in a standard fashion.  For their special needs, however, fortification is highly recommended. It is second best when fortified own mother’s milk is not available.
    6. Preterm formula -  is used when mother’s breast milk is insufficient, there is no donor’s milk bank and the baby is <1500gm and/or not gaining weight adequately. 30% of the estimated total feeding requirement, is spread over the 24-hour period and given before each feeding session by cup or dropper.