Feeding Your Infant in the NICU CEAC 0055 April 2018 *This document was designed to support patients of the former RQHR. Table of Contents Ways Your baby may be fed in NICU 4-5 Nipple shields 6 Bottle Nipples 6 Oral Immune Therapy 6 S.I.N.C. 6 Cue based feeds 7 Baby feeding cues 8 Kangaroo Care (Skin to Skin ) 9 Human Breast Milk and Breastfeeding The benefits of human breast milk 10 When baby is not able to breastfeed Expressing breast milk 11 When to pump 11 How much breast milk should you be expressing 12 Hand expressing breast milk 13 Expressing breast milk using a pump 14 Ameda Platinum® Breast Pump Ameda Platinum® breast pump quick start guide 15 Set up and Assembly of the milk collection system 16 Pump diagram 17 Using the breast pump 18 Troubleshooting the breast pump 19 Storing expressed breast milk 20 Breastfeeding Learning to breastfeed 21 Feeding a sleepy baby 22 Breast compressions 22 Burping baby 22 Breastfeeding positions 23 Latching baby to breast 24 Nipple care 25 Management of nipple pain and trauma 25 1 Table of Contents Build up your milk supply 26 What can decrease your milk supply 26 If baby requires a special formula 26 Going Home How will you continue to breastfeed 27 Cleaning equipment at home 27 Storing breast milk after baby goes home 28 Thawing breast milk at home 28 Taking Care of Yourself Mom’s Nutrition 29-30 Rest 30 Keeping Breasts Healthy Sore Nipples 31 Engorged Breasts 32 Thrush 33 Plugged Ducts 34 Mastitis 35 Cleaning, Equipment, Preparing and Storing Milk Cleaning Breast pump kits at the hospital 36 Cleaning and sterilizing breast pump equipment at home 37 Cleaning and sterilizing bottles and equipment 38 Water to make formula at home 39 How to sterilize water 40 Preparing formula 40-41 Storing formula 42 Contacts & Resources 43-45 Breast pumping log 46-48 Photographs courtesy of RQHR Medical Media Services Department unless otherwise noted. All information pertaining to the Ameda Platinum® Breast pumps, kits & nipple shields including the reference guides with associated pictures. Use and cleaning instructions for pumps, pump kits and nipple shields/flanges including associated pictures are copyrighted materials owned by Ameda, Inc. and used with permission. 2 Congratulations on the birth of your baby! Your new baby will need to spend some time in the Neonatal Intensive Care Unit (NICU). The NICU has special equipment and staff who work around the clock to provide your baby the best care possible. You may be feeling overwhelmed or scared. These are common feelings to have when your baby is in NICU. You are not alone, the nurses and staff are there to help you. Every woman’s journey to motherhood is different. Before your baby was born, you may have decided if you were going to breastfeed or bottle feed your baby. Now your baby is in NICU and you may need to change your plans. This may be very upsetting for you. Talk with your baby`s nurse or medical social worker. Your baby may not be strong enough to breast or formula feed or may not have the suck, swallow, breathing coordination to fully breast or formula feed. These skills develop around 36-37 weeks gestation. Most babies will practice feeding sooner. All babies are different and start practicing feeding at different times. Know that being there for your baby as much as you can is important. The way your baby is fed depends on his medical condition and his ability to suck and swallow. Your baby’s NICU nurse will help you to learn how to feed your baby by whichever method you choose; breastfeeding or formula feeding A lactation consultant (LC, a breastfeeding specialist), is also available to assist you if you have chosen to breastfeed. This booklet will provide you with information to help you feed your baby. 3 Ways your baby may be fed in NICU Intravenous feeding Babies who are very premature or sick often are fed through and intravenous (IV). A small tube (catheter) is put in a vein in baby’s hand, foot, scalp or umbilicus (belly button) and taped in place. They will receive fluids and nutrients through the IV to help them grow. The IV fluid may be yellow in colour. They may also receive Lipids– a white liquid that provides them with fats to help him grow. This type of nutrition is called Total Parental Nutrition or TPN. Tube Feeding Premature babies are sleepier and have less energy than babies born at term. They can not coordinate sucking, swallowing and breathing. This makes it hard to feed. Babies who are too weak or sick to breast or bottle feed may need to be fed through a tube inserted into their stomach (gavage feeding). If the tube is put in through the nose it is called a nasogastric tube (NG tube). If the tube goes in through the mouth it is called an orogastric tube (OG tube). Many babies who are tube fed can breast or bottle feed. You can still breastfeed while your baby has a tube in the nose. Sometimes babies are fed through an IV and a feeding tube. Your baby may have a condition that requires a different kind of feeding tube called a gastrostomy tube (G-tube or gastric feeding tube). Surgery is done to put the tube directly into the baby`s stomach. Your baby`s nurse will teach you how to feed your baby and care for the G-tube. Babies with a G-tube may sometimes be able to breast or bottle fed. Bottle feeding and Formula feeds See Infant Formula Feeding booklet If you have chosen to bottle or formula feed your baby ask your baby’s nurse: If you can bottle feed your baby How to bottle your baby How often to bottle your baby How to make sure your baby is getting enough milk-not too much or too little when you bottle your baby. If you are using infant formula, it is important to know how to safely prepare, use and store it. Follow the instructions on the liquid concentrate or powdered formula cans when preparing. If your baby will be going home on a special formula, the NICU dietician will discuss with you how to safely prepare, store and feed this formula as well as where to purchase this special formula in your community. Pages 37-38 cleaning and sterilizing bottles and equipment at home Pages 39-40: choosing and sterilizing water for formula Pages 40-42: preparing and storing formula 4 Breastfeeding Some babies can breastfeed, while others may need to get breast milk from a bottle or feeding tube. Ask your baby’s nurse or lactation consultant: If you can breastfeed your baby How to breastfeed your baby How often to breastfeed your baby How to make sure your baby is getting enough milk How to pump and store your breast milk for later use, if your baby is not ready to breastfeed. Donor Human Milk (DHM) A woman’s own breast milk provides the best nutrition and health benefits for her baby. Sometimes a mother’s breast milk may not be available. When this happens, donor human milk is the next best thing for most preterm or sick babies. DHM is ideally intended to be a temporary measure until you are making enough or more breast milk. Formula is not the same as a mother’s own breast milk or donor human milk. Your consent is needed before donor human milk is given to your baby. Your baby’s doctor, will discuss this with you and obtain your informed consent. Your nurse or dietician will talk with and answer any questions you may have about donor human milk. Note: Babies do not go home on donor human milk. Non-nutritive sucking Once your baby is stable and the health care team says it is okay, let your baby practice sucking at your breast to get ready for breastfeeding. Non nutritive sucking helps to satisfy baby’s urge to suck. It helps with coordination of breathing and sucking, helps with digestion and can help to soothe your baby. Express by hand or pump your breasts until they are empty. Pick up and hold your baby and let him touch and taste your breast to get used to what breastfeeding is like. This is called non-nutritive sucking. Sucking on your finger or using a pacifier are other ways for your baby to practice sucking and breathing. Supplementation Your baby may require the use of a preterm formula or human milk fortifier while in NICU. Preterm formula and human milk fortifier provide additional calories, protein, essential fatty acids, vitamins, and minerals that preterm babies need for best growth and development. A preterm formula may be used for the period of time prior to your milk coming in. Human milk fortifier is added to your breast milk. Preterm formula and human milk formula, in addition to your breast milk, improve baby’s growth, bone strength, and the development of all organs such as the brain, eyes, lungs, and heart. 5 Nipple shields You may need to use a nipple shield to feed your premature baby for a variety of reasons. They can be used for babies who have a hard time latching on, and are offered at no charge for NICU babies. Together with your nurse or lactation consultant you can decide if you need one and which size is best for you and your baby.