Transition to at-breast feeding

Breastfeeding is the ultimate goal for the preterm / sick infant and mother pair. NICU infants, however, have a unique set of challenges, which may make it difficult to breastfeed initially. The infants’ progression to breastfeeding is often complicated by prematurity, neurological, gastro-immaturity and underlying medical co-morbidities.

Supporting practices such as oral therapy, skin-to-skin contact and non-nutritive sucking (NNS) are not only critically important to the infants’ development and relationship with their parents. Studies have shown that these practices support maternal milk volumes and the infant’s transition from enteral feeds to breastfeeding, thus leading to higher breastfeeding rates and optimised long-term health benefits.^7–11

Woman sitting on a couch holding a newborn baby and kissing the baby's hand.

Transition to at-breast feeding

Breastfeeding rates – Transition to at-breast feeding results

A premature baby receives oral therapy in the NICU.

Transition to at-breast feeding

Oral therapy with own mother’s milk (OMM) – Transition to at-breast feeding interventions

A premature baby has skin-to-skin contact with its mother.

Transition to at-breast feeding

Skin-to-skin care – Transition to at-breast feeding interventions

A mother breastfeeds her premature baby.

Transition to at-breast feeding

Transitioning to direct feeding at breast –Transition to at-breast feeding interventions

Woman sitting on a couch holding a newborn baby and kissing the baby's hand.

Transition to at-breast feeding

Breastfeeding rates – Transition to at-breast feeding results

A premature baby receives oral therapy in the NICU.

Transition to at-breast feeding

Oral therapy with own mother’s milk (OMM) – Transition to at-breast feeding interventions

A premature baby has skin-to-skin contact with its mother.

Transition to at-breast feeding

Skin-to-skin care – Transition to at-breast feeding interventions

A mother breastfeeds her premature baby.

Transition to at-breast feeding

Transitioning to direct feeding at breast –Transition to at-breast feeding interventions

References

1 Bigger HR et al. Quality indicators for human milk use in very low-birthweight infants: are we measuring what we should be measuring? J Perinatol. 2014; 34(4):287–291.

2 Spatz DL et al. Pump Early, Pump Often: A Continuous Quality Improvement Project. J Perinat Educ. 2015; 24(3):160–170.

3 Spatz DL. Getting it right – the critical window to effectively establish lactation. Infant. 2020; 16(2):58–60.

4 Meier PP. Prioritizing High-Dose Long Exposure to Mothers' Own Milk During the Neonatal Intensive Care Unit Hospitalization. Breastfeed Med. 2019; 14(S1):S20-S21.

5 Hoban R et al. Milk volume at 2 weeks predicts mother's own milk feeding at neonatal intensive care unit discharge for very low birthweight infants. Breastfeed Med. 2018; 13(2):135–141.

6 Meier PP et al. Human milk in the neonatal intensive care unit. In: Family Larsson-Rosenquist Foundation, editor. Breastfeeding and breast milk - From biochemistry to impact: A multidisciplinary introduction. 1st ed. Stuttgart: Thieme; 2018.

7 Snyder R et al. Early provision of oropharyngeal colostrum leads to sustained breast milk feedings in preterm infants. PediatrNeonatol. 2017; 58(6):534–540.

8 Kumar J et al. Oropharyngeal application of colostrum or mother's own milk in preterm infants: a systematic review and meta-analysis. Nutr Rev. 2023; 81(10):1254–1266.

9 Acuña-Muga J et al. Volume of milk obtained in relation to location and circumstances of expression in mothers of very low birth weight infants. J Hum Lact. 2014; 30(1):41–46.

10 Haase B et al. The development of an accurate test weighing technique for preterm and high-risk hospitalized infants. Breastfeed Med. 2009; 4(3):151–156.

11 Narayanan I et al. Sucking on the 'emptied' breast: non-nutritive sucking with a difference. Arch Dis Child. 1991; 66(2):241–244.