Medidas Medical Center INC Lactation Training Management Sesion 10 Session-10-Infants-with-Special-meeds

1. INFANTS
WITH
SPECIAL NEEDS

2. OBJECTIVES
 1. Preterm, low birth weight who
have special needs
 2.twins, triplets and babies with
congenital anomalies
 3. Prevention and management of
common clinical concerns
 4. Medical indications for use of
foods/fluids other than breastmilk

3. I- Breastfeeding infants who are
preterm, low birth weight or ill
Breastmilk is important for these
babies because of:
• protective immune factors,
• growth factors
• enzymes
• special essential fatty acids

4. Breastfeeding infants who are PT, LBW or ill
Why BREASTFEEDING ?
• calms the baby and reduces pain
• gives the mother an important
role in caring for her baby,
• comforts the baby and maintains
the link with the family.

5. PRETERM <37 Weeks Have the
following 4 Main Feeding Problems:
Feeding is delayed because of problems
associated with prematurity
►He has difficulty in taking milk
►His stomach cannot hold large
amount of milk
►His digestion is easily upset by large
intake
►For his weight, more calories is
needed than a full size full term baby

6. 3 STAGES OF SUCK-SWALLOW
PATTERN DEVELOPMENT
 Mouthing stage
 Immature suck-swallow: short sucking
bouts preceded by or followed by
swallowing
 Mature suck: more rapid burst of
sucking with swallowing occuring
concurrently with sucking

7. Advantages of Breastmilk in Feeding
the Prematures and Sick Neonates
Milk expressed from “preterm” mother
have high concentration of :
Nitrogen
Protein than
Sodium Chloride “Term”
Calcium Mother
Fatty Acids

8. Benefits of Breastmilk
Feeding for Preterm Infants
1. Reduced incidence of infections / NEC
2. Improved feeding tolerance
3. Enhanced neurodevelopment
4. Enhanced family bonding, maternal
involvement and interaction
5. Enhanced maternal self-esteem and maternal
role attainment

9. Determining Readiness to
Breastfeed
1. Gestational Age: 32-34 weeks
2. Physiologic Stability: Absence of
tachypnea, pallor, mottling, apnea,
bradycardia, O2 desaturation

10. Determining Readiness to Breastfeed
3. Sleep/ Wake states (Level of
Arousal)
a. Quiet sleep c. Drowsy e. Active
Alert
b. Active sleep d. Quiet Alert
f. Crying
4. Mature vs Immature Suck
Pattern
5.Behavioural Cues

11. Recommended Methods of
Supplementation
1. Gavage Feeding
2. Cup feeding - 30 ml medicine
cup
3. . Lactation Aids

12. Support for breastfeeding in
the Special care baby unit
• Arrange contact between
mother and baby, day and
night.
• Encourage the mother to visit,
touch, and care for her baby

13. Support for breastfeeding in the SCU
Take care of the mother -
provide a bed. food and fluids
Help to establish breastfeeding:
- Assist the mother
 express her milk, within 6 hours
of birth, 6x or more / day
 correct attachment and
positioning
- Encourage babies to spend
time at the breast as early as
possible

14. Explain to mother what to expect
when feeding a premature
Baby may be too sleepy or fuzzy and will
probably feed and pause for a long time
Expect some gulping and choking,
Mother can continue to hold her baby
against her breast without trying to initiate
suckling.
Keep the feed as calm as possible.

15. Prepare the mother and baby for discharge
1. Baby medically stable
2. feeding effectively and gaining
weight –(at least 1800–2000 gm)
3. mother can recognize feeding signs
and signs of adequate intake
4. able to position and attach her baby
well
5. knows how she can get assistance

16. II Breastfeeding more than
one baby
Mothers can make enough milk for two babies, and even
three.
 DO NOT GENERALIZE!
- Make careful assessment of the pregnancy
Assess the mother’s physical and emotional status
Assess each infant’s health and development abilities
 Encourage the mother to:
- Eat a varied diet and take care of herself.
- Get help – family support is very important

18. OTHER PROBLEMS
Hypoglycemia of the newborn
Healthy full tem infants:
 There is no evidence that
hypoglycemia in the absence of any
signs of illness is harmful.
 They do not develop hypoglycemia
simply through under-feeding.
If signs of hypoglycemia develops, it is
usually accompanied by other signs
of illness , investigate for underlying
illness (sepsis) See reference materials

19. Jaundice
(hyperbilirubinemia)
 Almost 60-70% of all newborns
develop jaundice in the first few days
of life.
- in prematures, incidence is > 80%
 Physiologic jaundice.
- common, and considered normal
- appears on the 2-3 days to 10 days
of life

20. Breastfeeding
Jaundice
Breastmilk
Jaundice
Incidence 3% <1%
Age of
onset
3 – 4 days of lifeEnd of first week
persists for 3
weeks to 3
months
Etiology Lack of BM,
poor feeding,
H20
supplementation
Substance in milk
in some mothers

21. Breastfeeding
Jaundice
Breastmilk
Jaundice
Prevention 8 – 12 feedings /24 hours
night & day
Effective BF
Frequent stooling
No supplementary fluids
Give EBM if needed to
increase volume intake

22. Breastfeeding
Jaundice
Breastmilk
Jaundice
Management
Same as
prevention
Exclude other
causes
Do not stop
breastfeed ing
BIL > 20 mg /100 ml
INTERRUPT
Nursing 24– 48 hrs.
Or boil her milk and
give for 3 days. Then
resume direct BF
Further Evaluation
If > 15.5 mg /100 ml o
Bilirubin
or

23. Babies who have Breathing
difficulties
Should be fed small amounts
frequently as they tire easily.
Breastfeeding provides the
infant with:
nutrients, immune bodies,
calories, fluid and comforts the
distressed baby and mother.

24. Dehydration
Healthy exclusively breastfed infants do
not require additional fluids
Babies with diarrhea should be
breastfed more frequently.
Frequent breastfeeding provides fluid,
nutrients, and provides protective
factors.
In addition to its growth factors,
breastmilk, aids in the re-growth of the
damaged intestine.

25. BABIES WITH
NEUROLOGIC PROBLEMS
Encourage early contact and
feeding.
May need to be awakened for
frequent breastfeeds and
stimulated to remain alert
during feeding.

26. BABIES WITH NEUROLOGIC PROBLEMS
Help the mother to position and
attach the baby well.
Help mother support her breast
TO maintain good attachment
(Dancer’s Hold)

27. Cardiac problems
Babies may tire easily. Short
frequent feeds
Baby can breathe better when BF
Breastfeeding is less stressful
better weight gain.
Breastmilk provides protection and
helping growth and development.

28. Cleft lip and palate
o Breastfeeding is possible,
even in extreme cases of
cleft lip/palate.
o Babies with clefts are at risk
for otitis media and upper
respiratory infections

29. Cleft palate management
 Hold the baby with nose and
throat higher than the breast
 Breast tissue or the mother's
finger can fill a cleft in the lip
 Feedings are likely to be long – be
patient
 May use EBM and feed by a cup.
 Resume breastfeeding when baby
is alert following surgery

30. Cleft Lip
1. Position your nipple to one side of
the cleft
2. Use your thumb to fill the defect
Treatment: Obturator
Surgery

31. Acceptable Medical Reasons
for supplementation
There is a small number of situation that
maybe considered as medical indication for
 SUPPLEMENTING breastmilk or
 for NOT USING breastmilk…..
Exclusive breastfeeding IS THE NORM

32. 1. Infants who cannot be fed at the breast
but breastmilk still remains the food of
choice
ex…infant weak / oral abnormality /
separated from mom
2. Infants who may need other nutrition
in addition to breastmilk
ex…LBW or preterm < 1500 gms or <32
weeks / infants at risk of hypoglycemia
because of medical problem
Acceptable Medical Reasons
for supplementation

33.  Ensure that the
baby gets the hind
milk that has a high
fat content to help
the baby grow.

34. BGH-MC PNCU Milk Bank
BGH-MC NICU Nov 25 2008

35. 3. Infants who should not receive
breastmilk or any other milk
including the usual BM susbstitutes
ex…inborn errors of metabolism like
galactosemia / phenylketonuria

36. PHENYLKETONURIA (PKU)
• Abnormal amino acid metabolism:
absence of phenylalanine
hydroxylase Excess PA &
metabolites phenylpyruvic acid &
phenylethylamine
• Acidosis
• Treatment: Low PA diet
Special milk formula
Acceptable Medical Reasons

37. • Abnormal metabolism of 3 BCCA’s:
Valine, Leucine & Isoleucine
• Defective oxidative decarboxylation
increase V,L,I & metabolites
(Keto-acid derivatives)
• Mental retardation, acidosis, death
• Treatment: MSUD milk
Acceptable Medical Reasons
MAPLE SYRUP URINE
DISEASE (MSUD)

38. • Defect 1: Deficient Galactokinase
Increase galactose in
blood & urine
Cataracts – no mental retardation,
no aciduria
• Defect 2: Deficient Galactose 1
PO4 uridyl transferase
Increase Galactose 1 PO4
a aciduria & mental
retardation, hypoglycemia, death
• Treatment: Galactose Free Diet
Acceptable Medical Reasons
GALACTOSEMIA

39. 4. Infants for whom breastmilk is
not available
ex… mother who died
no nursing mother available

40. 5.Maternal conditions that affect
breastfeeding recommendations
• mother very weak
• mother taking medications
antimetabolities / radioactive
iodine / some anti-thyroid
• maternal addiction
tobacco / alcohol / drug
• HIV infected mothers
Acceptable Medical Reasons

41. SUMMARY
 1. Preterm, low birth weight who
have special needs
 2.twins, triplets and babies with
congenital anomalies
 3. Prevention and management of
common clinical concerns
 4. Medical indications for use of
foods/fluids other than breastmilk

42. LET US ALL
Protect
Promote
Support
BREASTFEEDING
THANK YOU