Have not seen that before but I believe our medical professionals do not believe those premies can do it so we do not even attempt.

I see it. It related to preterm infant and his or her mother and staff that train the mother

Lo hemos realizado, depende de cuan desarrollado este el reflejo de succión y que no tengan problemas respiratorios, pero si no ganan peso por el esfuerzo que genera gasto calorico, es mejor poner una sonda para alimentarlos con leche extraída de la propia madre (no de banco de leche de otras madres por el riesgo de transmisión de VIH) ya que la leche es especifica de la madre para el RN, funciona mejor si se ha educado a la madre para dar de lactar, y se reinicia el amamantamiento una vez que ha empezado una aceleración de peso sostenida por varios días. Un buen manual de referencia y protocolos de alimentación al neonato es el Manual of Neonatology por John P. CLOHERTY capitulo Braestfeeeding por Nancy Hurst no todo bebe de esa edad puede ser amamantado, eso es trabajo de equipo y de las condiciones del Neonato.

We have done it, it depends on how developed the suction reflex is and that they do not have breathing,etc. problems, but if they do not gain weight due to the effort work suction that generates caloric lose, it is better to put a tube to feed them with milk extracted from the mother (not from milk bank of other mothers because of the risk of HIV transmission) since the milk is specific of the mother for the RN, it works better if the mother has been educated to breastfeed, and breastfeeding is reinitiated once that Neonate has started a sustained acceleration of weight for several days. A good reference manual and feeding protocols for the newborn is the Manual of Neonatology by John P. CLOHERTY chapter Braestfeeeding by Nancy Hurst, ( Transition to breast/bottle feedings is a gradual process. Infants who are approximately 33 to 34 weeks’ gestation, who have coordinated suck– swallow– breathe patterns and respiratory rates 60 per minute, are appropriate candidates for introducing breast/bottle feedings) not every baby of that age can be breastfed, that is a team work and the conditions of the Neonate.

Yes. Being preterm does not mean a baby will not be able to breastfeed. Although preterm at 34 weeks may be slow to establish breastfeeding, in the neonatal unit we supplement with tube feed until they establish feeds. Breastfeeding is best for all babies and is recommended by the WHO unless mother is unable to breast for medical reasons.

The sucking reflex may be active from 34 weeks though may be uncoordinated or infant tire easily. If baby and mother are given opportunities and effective support baby can develop their suckling skills at the beast and this is routine practice in some units. If neonatal unit staff do not have time, knowledge or skills then a bottle and artificial teat are often used as a speedy intervention though research has shown this intervention may reduce the likelihood of continued breastfeeding and thus increase risks to the infant. There is research on this topic. http://www.ilca.org/main/learning/resources/neo-bfhi is a good place to start finding out more.

Thank You everyone! Yes as a NICU RN and a IBCLC lactation consultant I have been placing extremely premature infants skin to skin on their mother's chest since the 1990's at USC, and we have had great success with our premies being able to scoot to the breast and begin learning how to coordinate the suck swallow breath reflex between the 32 to 34 week area. We are a level 3 NICU and our staff are quite comfortable with assisting mothers with skin to skin and laid back baby led breast feeding (tummy to tummy). Dr. Rangasamy Ramanathan our NICU Medical Director was involved in the creation of the Ram cannula, which has greatly assisted our breastfeeding in our unit. Babies utilize less energy suckling at the breast then at the bottle as it is less stressful due to the coordination of the suck swallow breathe. Our babies begin non nutritive feedings at the breast along with their pumped breast milk or formula that would be given via gavage for assured calorie intake. We also utilize the supplemental nursing system (SNS) to provide premature formula supplementation while breastfeeding at the breast, and or additional breast milk that mother pumped and brought from home.

When babies are fed bottles in the NICU often times they prefer not to breastfeed when they are discharged home, as the flow is much slower and the artificial nipple has already been imprinted in their memory. Prior to discharge I utilize the SNS and Nipple Shield so that the parents feel comfortable using this tool as they transition the baby to breast feeding before that special day arrives.

I agree with Melissa. In our experience, early skin to skin has allowed infants to recognize the breast faster by 32-34 weeks, to promote brief but early latches, and then progress to more successful breastfeeding as their clinical status improves. We use fortified supplementation to support growth that continues, in many cases, for a short period after discharge.

Mothers also show greater skill and confidence prior to discharge.