How to breastfeeding premature newborn baby

The breastfeeding mothers often encounter problems that could have been avoided, but many governance in Hospital it difficult for the mother and baby to successfully carry out the process of breastfeeding well. It becomes more difficult when it turns out the baby is born prematurely, whereas premature babies in desperate need of breastfeeding and need to breastfeed more often than babies born at term. The mothers with premature babies still get help with "techniques" developed in the era 1960-1970an. ASI, especially breastfeeding, not the top priority in the NICU (Neonatal Intensive Care Unit, intensive care for newborns). Unfortunately, even after such a long time we learn how best to help mothers and babies in the nursing process, NICU still can not accept this way. Even some of the new techniques are applied only makes the situation worse.
Some Myths about Premature Babies and Breastfeeding Process

1. Premature Babies need to enter the incubator
Premature babies, even though very little is actually more in need of skin contact with the mother (or father) rather than put in the incubator. Evidence suggests that the metabolism of a premature baby (or babies with special needs) is much more stable when attached / skin contact with the mother. Baby breath more stable, more relaxed and calm, more normal blood pressure, blood sugar levels as well as their skin temperature was better. All this happened when they were treated with the method Kangaroo (Kangaroo Mother Care) that perform skin contact between mother and baby most of the day. Even mothers who do this Kangaroo method can produce more breast milk, she can breastfeed her baby more quickly and the baby will suckle better. A document from the WHO to discuss it at length with various references.

2. All premature babies need extra intake (fortifier)
Actually, the majority of premature babies do not require an additional intake. If the mother is able to express the milk, infants weighing 1,500 grams (infants with gestational age of 32 weeks weighs in the range of 1500 grams, although there are some exceptions) can grow well only with breast milk alone, with the possible addition of vitamin D or phosphorus, perhaps.
"Needs" will be an additional intake seakanmenjadi sort of scripture engraved in the inscription. Many (if not called majority) NICU implement a policy that all premature babies should grow in level and the same speed, as if they were not born early. There is strong evidence showing that babies grow faster (with an additional intake-editor) will soon have problems such as the levels of "bad" cholesterol is higher, higher blood pressure, immunity to insulin (which may be an early symptom of diabetes 2), and obese) compared to premature babies who are breastfed. Research was conducted on three groups of premature babies: those that direct nursing, nursing groups directly and got donor breast milk, and the group given an additional intake of milk with formula. This latter group are growing faster and bigger, but there is a price that must be paid at a later date.
How to give a baby without any additional intake? First of all, some babies do need additional intake, the baby is very, very tiny and infants whose mothers can not remove enough milk. Currently there is an additional intake made from human milk (ASI), unfortunately quite difficult to obtain and is relatively expensive. Although there is no reason that an additional intake should be made from cow's milk. However the majority of premature babies do not require additional intake because they have a heavy 'enough'.
Many NICU apply the rule that babies can only accept a certain amount of fluid a day. Usually in the range of 150-180 ml / kg / day, or even less. If the baby is infused, oral fluids even further reduced. Fluid restriction is reasonable when for example the baby on a ventilator (ventilator). Too much water can cause heart failure and closing the ventilatornya. As a result of the restrictions (intake) of liquid plus the assumption "still have to grow as the baby in the womb" generates the need for additional intake / fortifier.
There I learned when I worked in Africa. One way to avoid 'need' for additional intake in premature infants turns out is by giving them more milk than is 'allowed' in the NICU. True, physically African babies is not like babies in the NICU developed countries are larger, healthier and require less assistance breathing for survival. But as people who believe in the law "infants should grow as if he was still in the womb" at that time, I (Jack Newman) increase the amount of milk (ASI) to above 150-180 ml / kg / day, sometimes even 300 ml / kg / day and the babies are fine and are growing well. So that breastfeeding is not too much at any time, the milk is dripped directly into his mouth on an ongoing basis, by shedding a few times in one time.

There is the possibility of adding the intake in addition to breast milk, depending on the levels of what is lacking in the blood of infants. The addition of vitamin D, phosphorus, calcium, even a human protein (albumin) and human milk fat (of donor breast milk) is possible without having to use fortifier. It could be said fortifier is thinning, given the lower the concentration of all the elements (the ASI) which makes special and unique breast milk.

3. Premature babies can not be attached to the breast when not aged 34 weeks (gestation)
This is absolutely not true. During (I-Jack Newman) working in the NICU Breastfeeding friendly, especially in Sweden, (I've seen) premature babies may reach the breast even babies born at 28 weeks gestation though. In premature infants born at 30 weeks also they can attach and suckle directly from the breast. Some babies (new) who was born at 32 weeks can suckle even full. Full breastfeeding means feeding directly at the breast alone, without the help of breastfeeding over bottle or hose. Use Kangaroo method, and introduces the breast as soon as possible after birth increases the chances of babies are breastfed full. This method can be done anywhere
Of course, every baby is unique and different. Some babies may require a longer time, depending on whether they are experiencing problems in the respiratory system, or there are other medical indications. However there is a benchmark that is very unfortunate for premature babies feeding is done through the bottle until the baby is aged 34 weeks (gestation) and then introduced to her mother's breast.
Take a look at the following article, or refer to your pediatrician at the following article:
Nyqvist K. The development of preterm infants' breastfeeding behavior. Early
Human Development; 1999; 55: 247-264
Nyqvist K. Early Attainment of breastfeeding competence in very preterm infants, Acta Paediatrica 2008; 97: 776-781
4. Mothers of premature babies should use nipple shields so that the baby can attach well and can suckle well
This of course is not true. Based on my experience in Africa largely (in fact, we never) use nipple shields, as well as experience working in the NICU in other countries such as Sweden. Nyqvist, the second article tells been handling babies born between 26-31 weeks gestation and only a fraction are using a nipple shield. The result almost all the baby home from the hospital has been able to suckle directly from the breast. Different condition to what happened in the NICU in North America. There is little babies are already able to suckle directly from the breast when they are out of the hospital (formerly the most good that breastfed infants through a bottle while rarely put the baby to the mother's breast).
The real key is to be patient (and take the time) to teach the baby to know the breast properly. It does require a longer time than mothers using nipple shields, but the long-term benefit is worth. Nipple shields actually result in reduced milk production, which makes the process separated from the nipple shield to be very difficult (see the information sheet If Baby Could Not Attached to the breast).
How to help a premature baby is attached to the breast is almost the same as the baby is old enough. See the information sheet When Fitted and watch video clips d Video-video clips (does) not show premature babies, but the attachment process in principle remains the same.

5. Premature babies need (need) a bottle in order to learn to suck properly
I do not know what to say about this. This myth is totally wrong. Premature babies can learn to suck naturally, does not need to be taught with the bottle. And this, again, apply anywhere in the world. Often, the mother and the baby is premature to hasten out of the hospital with the 'advice' that the baby will go home sooner if the baby using a bottle. This is not the right way to help the mother and baby. In any case, the baby did not need the bottle to learn to suckle. Kangaroo Method implement and introduce the baby to the breast immediately by ignoring the 'benchmark magic' 34 weeks (gestation) would help avoid this situation. Besides

6. Premature babies are more tired when it is attached to the breast
This is believed to be a myth that is true for all babies, not just premature babies alone, tend to fall asleep at the breast when the flow of milk is slow, especially in the first few weeks. When the baby is given the milk in the bottle, because the flow is fast, the baby woke up and suck it firmly. Erroneous conclusions that arise? Baby fatigue in breast because direct feeding is hard work while drinking with a bottle much easier.
Premature babies often can not adhere well, due in part to the way we teach poor adhesion. Through good adhesion, using pressure (or compression) of the breast, and if necessary, use the tools as an aid to breastfeed on the breast, the baby will get a good flow of milk so as not to fall asleep while feeding at the breast. Improve the flow of breast milk, you will see that breastfeeding is not at all difficult and tiring for infants (premature).

7. Test weight (weigh the baby before and after nursing / receive intake) is a good way to know how much milk the baby is drinking
Test weight assume that we know what is supposed to be the baby in breast milk. How can we know, whereas the rules so that baby weight and age so had to get x amount of milk, based on a formula-fed baby in a bottle?

Then how can we say how much has been earned if the baby has been attached properly, with mothers using compression techniques in the breast, especially if breastfeeding is limited to a particular time or scheduled, for example 10 or 20 minutes (due to concerns that the baby fatigue)?
The best way to find out whether the baby get enough milk from the breast is by watching how a baby when feeding from the breast. Take a look at the video clips on the site

8. Premature infants should still obtain additional intake (fortifier) ​​despite being home from the hospital
This is a new idea that could interfere with a mother who was trying to breastfeed a premature baby. Perhaps someone once presented a paper at the conference showed babies have more weight if the intake of additional (non ASI) continued even after discharge from hospital. However, once again, more is not necessarily better and feeding is more important than adding more weight, which is not necessarily better. See additional information on intake (non ASI) above.

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