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SCOPE

DISEASE/CONDITION(S)

Address human milk and breastfeeding for the hospitalized infant.

GUIDELINE OBJECTIVE(S)

Understand the significance of human milk and breastfeeding for vulnerable infants; identify evidence-based practice principles to ensure infants receive human milk through hospital discharge; recommendations for transition to direct breastfeeding.

BRIEF BACKGROUND

The American Academy of Pediatrics recommends human milk and breastfeeding as the preferred form of nutrition for all infants. Human milk has specific health benefits for hospitalized and vulnerable infants.

Examples of how human milk influences health and developmental outcomes:

  • Decreased mortality and morbidity

  • Decreased incidence and severity of infections (ear, gastrointestinal, respiratory, urinary) and sepsis

  • Decreased incidence and severity of necrotizing enterocolitis

  • Improved feed tolerance, advancement of feeds for vulnerable infants (decreased total parenteral nutrition days)

  • Decreased retinopathy of prematurity

  • Decreased bronchopulmonary disease

  • Improved brain development (increase in white matter and gray matter) and improved intelligence and developmental outcomes

  • Decreased risk of sudden infant death syndrome

  • Improved long-term health outcomes (reduction in obesity, diabetes, heart disease)

  • Enhanced long-term protection of gastrointestinal system (reduction in irritable bowel syndrome, Crohn disease, celiac disease)

  • Reduced risk of childhood cancers (leukemia and lymphoma)

RECOMMENDATIONS

MAJOR RECOMMENDATIONS

Human milk is the preferred form of nutrition for all infants. All efforts should be made to help mothers make an informed decision to express milk for their infants. If mother’s own milk is not available or its use is contraindicated, pasteurized donor human milk (PDHM) should be utilized during the hospital stay. PDHM should never be viewed as a replacement to mother’s own milk, but rather a bridge. PDHM has a significant role in the reduction of necrotizing enterocolitis; however, does not have the same benefits as mother’s own milk for other health outcomes.

PRACTICE OPTIONS

Practice Option #1

Ensure that all families make an informed decision regarding the science of human milk and how human milk is a medical intervention. All families should receive antenatal counseling regarding human milk as a medical intervention. Families should receive specific information about how human milk will protect their infant from morbidity and mortality. Consider using specific education tailored to the neonatal intensive care unit (NICU) such as the Power of Pumping DVD.

Practice Option #2

Initiation and maintenance of maternal milk supply throughout the hospitalization is essential. Women are prepared to make milk for their infants no matter how early they deliver, as the breasts begin to secrete milk from 16 weeks of gestation onward (Lactogenesis I). Lactogenesis I refers to the period of time in which the mother is producing colostrum. Colostrum is of vital importance to the NICU infant, and colostrum should be specially labeled and fed to the infant in ...

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