Preemies and Breastfeeding

anya carissa just after birth

Anya Carissa is getting bigger and improving! They've removed all her tubes today, except for her IV which will be removed after her last dose of antibiotics at about 11pm tonight. She has been in the NICU for 1 week and 3 days. For the first time today, her parents were able to hold her, albeit briefly. Having a preemie niece made me think about several questions or issues on breastfeeding, hospital policies some of which I was able to clear up with Dr. Z.

1. No colostrum

As I mentioned in my earlier post, Anya's doctor did not want to give her colostrum for fear that she might choke. Instead, she was given glucose water via IV and for her first 2 feedings. After that, she was given my sister's breastmilk.

2. Use of bottles at the NICU

Anya started using a feeding tube. The tube was eventually replaced by a bottle. I asked why a bottle was used instead of a cup. The hospital prided itself as being breastfeeding friendly and in their nursery, I was under the impression that they used cups to feed the babies. I clarified this with Dr. Z who shared that for premature babies, there are experts who prefer bottlefeeding because of the risk of choking/aspiration and more effort required and calorie usage from the baby. This is why although full-term babies are cup-fed, NICU babies at this hospital are bottle-fed. Little Anya is now up to 30ml per feeding, although she feeds slowly. I think that slow feeding is quite normal -- Naima used to take 1-1.5hours to finish 2oz of milk.

3. Direct Breastfeeding

There are certain guidelines for breastfeeding preterm babies which are quite different. As Dr. Z emphasized, feeding is a very big issue in the NICU, and is a skill that a baby needs to be competent at before he or she goes home. La Leche League has a comprehensive resource page on feeding premature babies. You can also check this page from About.com for a quick overview. I wish I had read the About.com article earlier. One of the tips she had was: "Even if your baby is being fed intravenously, you can swab the colostrum inside her cheeks." -- this would've certainly been helpful in our case since my sister could just produce drops of colostrum then.

4. Kangaroo care
It was only today or more than 1 week after she was born that Anya was held by her parents. Since she was born, she was placed inside the incubator, with her parents just being allowed to hold her briefly through the holes of the incubator with gloves. Just recently, ABC News ran a story about how premature babies get lift from kangaroo care that helps give moms (and dads) purpose. It was actually identified as one of the greatest gifts NICU staff can give the preemies' parents. Then again, the article goes on to discuss about how some doctors draw the line when the baby's on a breathing tube -- and don't allow kangaroo care.
Baby Anya had been either on canula (oxygen tube) or ventilator since she was born. It was just last night when her breathing tubes were removed. Maybe this was why kangaroo care was only practiced by Anya and her parents today.

5. Milk Donations
In the course of my breastfeeding career with Naima, I have donated gallons of milk to different babies - singletons, twins, triplets, preemies, full-terms. Except for the milk I donated to the PCMC and PGH milk banks, I'm pretty sure that my milk was not pasteurized before being fed to the babies. Dr. Z again reminded me that the safest alternative to mother's milk is pasteurized donor milk OR directed donor milk from a screened donor.
I tried checking with UP-PGH on how to get my milk pasteurized for Anya but was unsuccessful. The PGH milk bank has a huge pasteurizer which runs only when they have collected 71 8oz. Dr. Edwards bottles. This is equivalent to about 568 ounces and they were nowhere near that! (side note: if you have extra milk, now would be a good time to donate -- PGH continuously accepts donated breastmilk). Even if I donate all my old stocks of milk in my freezer, we still wouldn't be able to run the pasteurization machine.
I still collected milk once daily and whatever milk I collected was stored in the NICU freezer for Anya in case my sister couldn't express enough. I felt that my milk also served to boost up my sister's confidence and prevent her from stressing too much about her milk production. Since she was relaxed when pumping, she was able to make enough for Anya's demand and so far, it was only once that they had to give Anya my breastmilk.

Once her IV tubes are removed, she will be transferred to a transition room where my sister will be allowed to try direct breastfeeding. Hopefully, Anya's improvement will be continuous and we will be allowed to bring her home by the end of this week.