Well premature babies usually at 35-36 gestation are often admitted to
postnatal wards with their mothers.
These babies should be offered the
breast as soon as possible after birth and then demand up to 3 hourly.
those who latch and suck well on the breast, there is no need for
Serum glucose may be checked if there is uncertainty about
feeding success or if there are risk factors (e.g., hypothermia).
On the other hand if the baby
does not show interest in feeding, is having difficulties latching, or does
not suckle for long, a supplementary feed will be required.
A feeding plan
needs to be individualised.
Feeding volumes should follow the recommended
Expressed breast milk is the food of choice, but if this is not
available in sufficient quantity, infant formula may be offered.
Advice may be sought from a Lactation Consultant.
Supplementation of breastfeeding is usually requested when there is concern
that baby is at risk for hypoglycaemia. In that context consider the
Expressed breast milk is
preferable to formula.
Significant birth asphyxia may be a risk factor for hypoglycaemia.
Such babies remain unwell after the initial resuscitation and are
admitted to NICU.
Term babies, depressed at birth, but responding
quickly and fully to resuscitation and are judged well enough to go to
the postnatal ward, should be considered well babies and encouraged to
proceed with normal breastfeeding.
Small for gestational
Keep in mind that babies below the 10th centile in birthweight are not
Consider such factors as ethnic background, parity and
maternal height which may influence birthweight.
babies with disparity between head circumference and weight are more at
risk for hypoglycaemia.
Infants of Diabetic
These babies who are clinically macrosomic are at a greater risk for
Babies with adequate weight for gestational age are at a
Should these babies require supplementation for initial
hypoglycaemia, attempt to expedite transfer to full breastfeeding.
Large for Gestational
advise checking glucose levels in babies above 4500g.
typically early in such babies and is rare beyond 8 hours of age.
feeding should be stressed again and any supplementation should be
limited to the initial few feeds, with attempts to expedite full
Occasionally babies are
seen on postnatal wards who may have been receiving suboptimal quantity
of breast milk, appear clinically dehydrated, may have had significant
weight loss from birthweight (7-10% below birthweight), may have elevated temperature and show
excessive sucking activity.
These babies need to be supplemented with
EBM/formula until they are clinically well.
To support breast
feeding, always offer breast feeds first and supplement after this.
Phototherapy causes an increase in insensible water loss and in
stool water contents, equivalent to 15-25ml/kg/day.
This should be
balanced by increased demand for breast milk in a well term baby who has
Thus routine supplementation of babies under
phototherapy is not recommended.
If breastfeeding is not well
established or baby appears clinically under-hydrated, then formula
supplementation is advised.
Breastfeeding and the use of
Human Milk. American Academy of Pediatrics Policy Statement. Pediatrics 100;