how to support families to breastfeed infants with special needs
- rooming in 24 hours a day
- SSC
- family centred care
- the three rules (feed, move milk, support triad)
extremely preterm
before 28 weeks gestation
moderately preterm
- 28-34 weeks gestation
what difficulties do premature infants face
- lack development for sustained oral feedings
- may be fed TPN, tube fe
at what gestation can preterm infant be able to coordinate sucking, swallowing and breathing
- early as 28 weeks but most commonly at 32-34 weeks
late preterm infant
- 34-37 weeks
- have difficulties like preterm even though they look term
approaches to help late pre-term infants feed
- freq. attempts followed by hand expression
- give expressed milk by spoon, cup, syringe
- SSC
- assess effective feeding
- weight loss - less than compared to term
for infants with special needs or preterm feeding schedule may need to be:
- strict feeding schedule about every 3H then go back to infant led
common issues for late preterm infants
- respiratory distress
- necrotizing enterocolitis (NEC)
- thermoregulation
- hypoglycaemia
why are preterm infants at risk for breathing problems?
- deficient surfactant levels, decreased number of functional alveoli
- small lumen airways
- weak gag reflex
periodic breathing for preterm infants
- is not apnea
- 5-10seconds pauses followed by 10-15 seconds of rapid respirations
what feeding method do late preterm infants do better in?
- breast feeding - uncharge of flow
- less apnea, hypoxia, and bradycardia
why are preterm infants susceptible to temperature instability?
- have large body surface area in relation to weight
- lack subcutaneous fat
- limited stores of brown fat
- inadequate muscle mass
- immature temp regualtion
signs and symptoms of hypoglycaemia
- jitteriness
- tremors
- exaggerated reflexes
- high pitch cry
- seizures
- hypotonia
- rapid breathing
What should be done to support mothers whose infants are diagnosed with hypoglycemia?
- Reassure them that nothing is wrong with their breastmilk * Initiate and maintain early and frequent breastfeedings * Start interventions to assist in establishing mother’s milk supply
why is hyperbilirubinemia more common in late preterm infants?
- immaturity of live
- decreased gastric motility
- increased breakdown of red blood cells
physiological jaundice
- common, develops after first 24 hours following birth
pathological jaundice
- occurs in the first 24 hours
- not normal and needs immediate attention
breastfeeding jaundice
- physiological
- associated with infrequent feeds
- delayed excretion of meconium
what are the benefits of bilirubin in infants
- increased antioxidants capacity in blood
- decreasing oxidative stress
low levels of serum bilirubin in newborns is associated with:
- intravascular hemorrhage
- retinopathy
- NEC
- atopic dermatitis
benefit son breastfeeding pre term infants are:
- improved immunity, digestion, absorption
- decreased morbidity and mortality
- increased neurological development
what is the different about milk for preterm to support their health?
- higher levels of immunoglobulins
- higher levels of protein, fatty acids, sodium chloride, iron
- colostrum helps prime the gut
behavioural characteristics of preterm infants are:
- longer drowsy states
- limited ability to handle visual stimuli
- stressed easily
- immature habituation
- poor muscle tone
- weak suck
- apnea events
