Best Practices for Human Milk in the NICU: An Expert Interview With Paula Meier, RN, DNSc, FAAN

Barbara Boughton

October 05, 2009

October 5, 2009 — Editor's note: The benefits of human breast milk for infants are well known, but what about for those in the neonatal intensive care unit (NICU)? A presentation highlighting the advantages and "best practices" for providing human breast milk in the NICU was held at the National Association of Neonatal Nurses 25th Annual Educational Conference, held September 23 to 26, 2009, in Austin, Texas.

To find out more about the scientific evidence and best procedures for using human breast milk in the NICU, Medscape Nurses interviewed presenter Paula Meier, RN, DNSc, FAAN, director for clinical research and lactation and professor of pediatrics at Rush University Medical Center in Chicago, Illinois. Dr. Meier has worked as a practitioner and researcher in the area of human milk, lactation, and breastfeeding for premature and NICU infants and their mothers since 1975.

Medscape: What are the benefits of human milk for infants in the NICU?

Dr. Meier: There are several studies that indicate that infants fed human milk instead of formula have a lower risk for several specific complications of prematurity. These include enteral feed intolerance, infection, necrotizing enterocolitis, chronic lung disease, and retinopathy of prematurity. There are also some new data that indicate that human milk may protect from periventricular leukomalacia. Babies who come home from the NICU after receiving breast milk score higher on developmental and neurocognitive tests than those who get formula. The more breast milk they get in the NICU, the higher their scores on these tests.

Early breast milk or colostrum — the milk made the first few days after birth — is especially nutritional for infants. It's more than food, it's medicine for the infants in the NICU.

Medscape: What are the barriers to using breast milk in the NICU?

Dr. Meier: Mothers are sometimes told that it's too stressful for them to breastfeed, or they shouldn't breastfeed because of an underlying condition. But most mothers, except those who are positive for HIV, have milk that is suitable for premature babies. There's almost no medication that a mother can take that would make her milk inappropriate. The mother's diet also has no effect whatsoever on whether she can make "good milk," although it may affect the fat content. Often, physicians and nurses don't give mothers the information they need to make a good decision about breastfeeding. But our message is unequivocal: your milk is medicine for your baby, and the only way your infant will get that medicine is for you to breastfeed.

Medscape: Are there strategies that can help women breastfeed infants in the NICU?

Dr. Meier: The main reason mothers give up on lactation early in the NICU is that they run out of milk. But mothers often just don't have the help they need. It's important that mothers use a hospital-grade electric breast pump, because it replaces the baby in terms of being an effective milk-removal agent. A mother should also have correctly fitted breast shields so that she can pump comfortably and effectively. Nurses can give mothers clear instructions for how long to pump and what is the expected milk volume. And there needs to be some consistency in following mothers during the time that we know they are most likely to establish a milk supply — during the first 3 weeks after birth.

Medscape: What are "best practices" for encouraging and monitoring breastfeeding in the NICU?

Dr. Meier: One model of care is to have breastfeeding counselors — similar to a program I introduced at Rush. Women in the NICU at Rush receive peer counseling from women who have gone through the same process. They're mothers who have been through similar experiences in the NICU and come from the same community. Right now we have 8 breastfeeding peer counselors who work with us in the NICU.

A mother should also monitor her own milk volume by measuring it. Someone in the hospital should check her milk volume records so that we know she's making enough milk and can intervene if she's not. We also recommend that all the milk that a woman makes be kept onsite at the hospital where it's temperature-controlled and in tamperproof containers.

Medscape: What are the recommendations for women after they bring their infants home from the NICU?

Dr. Meier: The baby should be breastfed for the duration of time recommended by the American Academy of Pediatrics. They're no different from other infants. So they should be breastfed at least through the first year of life. The benefits of human milk for infants extend through the first year and probably longer, although the effects after the first year haven't been as extensively studied in younger infants.

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