Transcript Managing Lactation Problems in the NICU

Managing Lactation
Problems in the Neonate
Kristi Palmer, M.D.
Neonatology
UAMS/Arkansas Children’s Hospital
Synagis
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Monoclonal Antibody
Given to all < 32 wk preemies
Hospitalization rates for RSV fell by 47%
Last winter 1200 children dosed in AR
Cost $7,082 per patient
Total bill = $8,498,400
Breastmilk
• Hospitalizations for pneumonia or bronchiolitis
less than 50% that of formula-fed babies
• Improves immune development
• Decreased risk for diabetes, Crohn’s, ulcerative
colitic, lymphoma, allergies, obesity
• Higher I.Q.
• 60% lower incidence of NEC
• Family saves $1000/year
Managing Lactation
Problems in the Neonate
Kristi Palmer, M.D.
Neonatology
UAMS/Arkansas Children’s Hospital
Benefits for mother
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Lower risk of postpartum bleeding
Faster weight loss after delivery
Fewer missed days of work
Decreased risk of ovarian and breast cancer
Lower risk of osteoporosis
Objectives
• Common myths
• Common lactation problems and basic
management
• Resources for physicians/nurses
Myths
• A postpartum patient should not breastfeed
because she is taking pain medicine or
“strong” antibiotics.
• The baby is sick, so mom cannot breastfeed.
• The baby is premature and too small to
nurse.
Contraindications to Breastfeeding
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Galactosemia
Mother using illicit drugs
Mother with active untreated TB
HIV (in developed countries)
Herpetic lesions on breast
Maternal Varicella
What can the
obstetrician/pediatrician do?
• Encourage the patient to consider
breastfeeding
• Inform her of the real health benefits for
herself and baby
• Provide written information
What can we do on L & D or
postpartum?
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Encourage Breastfeeding as the norm
Feed within the first hour
Keep baby with mother
Assess feedings regularly
Knowledgeable nurses
Lactation Consultant Services
Limit Supplementing
Encourage pumping if baby is not breastfeeding
Sleepy Baby/Problems Latching
• Wake the baby
• Correct Positioning
• Baby’s mouth opened
widely
Assessment Prior to Discharge
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Trained Observer
Assess Latch/Positioning/Adequacy of feed
Documentation every shift
Educate parents
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Positioning
Feeding cues
Feeding 8-12 times/day on demand
Diary of feeds/output
Pumping
When to call physician
Signs of adequate intake
• Audible Swallowing
• Minimal Weight Loss
– < 3% at 24 hours
– < 7% during first week
• Normal Output for age
– 1 wet/1 stool by 24 hours
– 6-8 wets/4 stools at 7 days
Follow-Up
• AAP recommendation – Office visit within
one to two days after discharge (by 2-4 days
of age)
• For < 38 weeks, weekly weight check until
40 weeks
• Feeding frequency, duration, supplements,
output, weight
Premature or Ill Baby
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Don’t forget to help mother start pumping
Save all milk
Label with date/time/medications
Store in refrigerator
or freezer
Engorgement
• Red Flag – Assess the baby
• Prevention
Nurse or pump frequently, limit supplements
• Treatment
Cold compresses between feedings
Warm compresses prior to
Pumping/Feeding
Pain Medication
Low Milk Supply/Growth Failure
• Maternal issues
• Infrequent/timed nursing
• Infant issues
– Difficult delivery/sedation
– Jaundice
– Infection
Mastitis
• Mother has flu-like symptoms:
– Fever, chills, aches
– Breast may be painful/warm/red
• Risk factors:
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Engorgement
skin breakdown
tight clothing
poor feeding
Mastitis
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Nurse or pump frequently
Warm compresses
Acetaminophen/ibuprofen for fever/pain
Antibiotics - 10 day course
– Clindamycin
– Cephalexin
– Augmentin
Maternal Medications
Mother should interrupt breastfeeding if
receiving:
Radioactive isotopes
Antimetabolites
Cancer chemotherapy agents
American Academy of Pediatrics, Committee on drugs. The transfer of drugs and other
chemicals into human milk. Pediatrics. 1994;93:137-150.
Medications: Principles to Consider
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Lipid Solubility
Maternal Plasma Levels
Molecular weight (< 500)
Protein Binding
T1/2
Infant Dose
Oral Absorption
Thomas Hale: Medications and
Mothers’ Milk
Information by Drug
• Pregnancy Risk
• Lactation Risk Category:
L1 to L5
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L1 Safest
L2 Safer
L3 Moderately Safe
L4 Possibly Hazardous
L5 Contraindicated
• AAP recommendations
• Alternatives
Thomas Hale: Clinical Therapy in
Breastfeeding Patients
Drug therapy listed by
maternal disease
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Mastitis
Postpartum Depression
Contraception
Hypertension
Diabetes
Who can I call?
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Hospital Lactation Specialist/Consultant
Area Health Department
WIC Breastfeeding Services
Arkansas Children’s Hospital Lactation
Consultant
WIC Breastfeeding Services
• Information Hotline for parents and health
professionals
• www.healthyarkansas.com/breastfeeding
• Provide pumps for mothers
• Peer counselors in some counties
• Educational opportunities
References
for the Health Professional
Resources
for the Health Professional
• AAP: Breastfeeding and the Use of Human Milk
Pediatrics Vol. 100, No. 6, Dec. 1997
• AAP: The Transfer of Drugs and Other Chemicals
Into Human Milk
Pediatrics Vol. 108, No. 3, Sept. 2001.
• Academy of Breastfeeding Medicine (protocols):
www.bfmed.org
• The Breastfeeding Answer Book
La Leche League International
www.healthyarkansas.com/breastfeeding
Information Sheets for Parents
• Planning ahead during
pregnancy
• Difficult Latch-On
• Sore Nipples
• Engorgement
• Mastitis
• Yeast Infection
• Storing Breastmilk
Written Materials:
for the parents
What about formal training?
• Contact WIC Breastfeeding Services
501-661-2905
• Arkansas Children’s Hospital/ADH
– Training for the health professional
– Conference Scheduled Sept. 28-30
501-364-1576