- The optimal care is for all babies to receive breast milk
only. This policy addresses those infants who do not need IV
fluids and whose mothers have not established a breast milk
supply.
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- In general, IV infusions should not be started if there are
no medical indications for IV fluids (such as respiratory
distress, hypoglycaemia etc.)
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- Babies who need feeding should be given what mother’s breast
milk is available and always receive mother’s breast milk in
preference to formula. Be sure to check that no breast milk is
available before considering infant formula.
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- If they require additional feeds, infants should then be started
on term infant formula, after discussion with their
mother/father. In such discussions, parents should be informed
that there are few - if any - adverse effects of formula used short
term in this way in a neonatal unit.
Click here to
review the evidence supporting this policy.
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- For a baby who is already on an IV infusion, it is
reasonable to continue the infusion for a short time if mother’s
milk supply is being established and there is a reasonable
expectation that she will be producing enough breast milk with
in a day or so. This time period needs to be judged against the
ease of IV access and the condition of the baby. Babies should
not have IVs re-inserted solely because no breast milk is
available.
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- Smaller preterm infants will often have a medical indication
for ongoing IV fluids and in them it is desirable to increase
the oral fluids slowly. The pace of increase of oral fluids can
usually be matched to the increase in the availability of
expressed breast milk.
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- Mothers should be advised and helped with
expressing. NICU
staff should discuss expressing as soon as possible. It is
accepted that the role of initially helping with expressing lies
with postnatal ward staff. NICU staff should support mothers’
expression of breast milk.
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- Nasogastric feeding rather than bottle or cup feeding is
advantageous for ex-premature babies. Term babies who do not
have problems with hypoglycaemia can usually transition directly
from IV fluids to breast feeds. Alternatively, bottle or tube
feeds may be used for larger infants.
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- NICU does not provide hydrolysed formula unless
there is a clinical indication (other than a history of
allergy). If there is a very strong family history of allergy,
hydrolysed formula may be supplied on an individual basis. Parents may supply their own formula (hydrolysed or non-cow’s
milk preparations) if they wish.
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