Wk 4: Infant feeding of the premature/sick neonate

Question 1

What positions are ideal for preterms?

Answer 1

• twin/football hold

Question 2

What are glactogogues?

Answer 2

= products that may help to increase breastmilk supply.
Can be foods, herbs or medications.

Question 3

What are some key principles of glactogogues?

Answer 3

• only work when breast milk is being removed frequently and effectively form the mothers breasts.
• When all factors contributing to a low supply have been identified and addressed, then galactagogues may assist to increase milk production

Question 4

What is the action of domperidone?

Answer 4

= A dopamine antagonist which to prescribed to enhance prolactin level
- Domperidone does not cross the blood-brain barrier

Question 5

What are the indications for domperidone?

Answer 5

= May be used when breast milk supply is low and when extra breastfeeding or expressing are not enough to increase milk supply.
- rarely used before seven days after birth.
- may be useful for mothers of premature babies, very sick newborns or adopting mothers as keeping up a milk supply can be difficult for some of these mothers.

• Domperidone demonstrated a moderate increase in daily breast milk volume of 88.3mL/day (ABA 2019 )

Question 6

What is the typical dosing of domperidone? and what is the management of this?

Answer 6

10 mg of Domperidone (one tablet) three times a day until breast milk supply is well established.

• This may take several weeks to take effect.
• A lactation consultant or doctor may increase the dose to 20 mg (two tablets) three times a day on occasions.
• The dose may vary depending on the woman’s milk supply, but a woman should not have more than 60 mg (six tablets) in one day.
• Once milk supply is well established, the dose can be decreased, e.g. 10 mg (one tablet) two times a day for one week, before stopping the medicine altogether.

Question 7

How long does domperidone take to work?

Answer 7

• make take 1 week
• importnt ot keep breastfeeding in this time.

Question 8

What is metaclopramide and what is its effect onbreastfeeding?

Answer 8

= prescription drug used to treat gastrointestinal disorders that has been used to increase breast milk production.

Question 9

Does metaclopramide cause side effects?

Answer 9

It can, as it crosses the blood-brain barrier, unlike domperidone.

Has the potential to cause central nervous system side effects such as restlessness, drowsiness, fatigue and depression.

Question 10

What is fenugreek?

Answer 10

= a herb/spice that is anecdotally used for increasing supply however there is no evidence to support this or assess its safety.

Question 11

How long does fenugreek take to work and what are some cautions to take?

Answer 11

• 1-3 days

Use with caution or avoid if a history of:
- Asthma
- Diabetes
- peanut or chickpea allergy
- multiple reports of maternal allergic reactions

Can cause:
- maple syrup urine and diarrhoae

Question 12

What is the fenugreek dose?

Answer 12

6,000 mg daily to boost supply

3,000 mg daily to maintain supply

Question 13

What is blessed thistle?

Answer 13

= plant used to boost milk production

• Limited clinical trials to know how it effective it is and how it works so must be taken with caution and appropriate healthcare support.

Question 14

What are some management principles of fortifiers?

Answer 14

= provides additional energy, protein, vitamins, minerals and salts needed to help growth and development in the premature and low birth weight neonate.

• Usually breast milk fortifier is added to the mother’s breast milk for neonates under 1500 gms and < 34 weeks gestation (This may vary from one organisation to another), once they are on full milk feeds.
• Neonates who are prescribed fortifiers are usually maintained on them until 4 weeks past their due date.
• If a neonate is receiving more than half of their feeds with formula, then fortifiers are NOT required.