Ensuring that each preterm infant receives optimal nutrition by supplementing the mother’s milk through personalised, targeted fortification designed to meet the infant’s unique nutritional needs.
The Preemie team spoke with Leilani Kupahu-Marino, a Registered Nurse who works at the Neonatal Intensive Care Unit at the Tripler Army Medical Center, in Hawaii, USA, to get her perspective on the journey that families face when their baby is born early and the challenges they have. Here is what she said:
“So, let’s start from the beginning. Mother is expecting to deliver this baby full-term, suddenly something happens, and Mother is brought into Emergency for either a C-Section or delivery. In those moments, everything is exploding in their world. Their life has changed from ‘Excitement’ to trauma as all of a sudden the baby is whisked away to the Neonatal Unit (NICU). Mother has not touched the baby and depending upon how preterm baby is, it may be several days before Mum has an opportunity to even see baby.
Our focus during this time is to stabilise the baby and ensure that Mum is well looked after.
As soon as possible, we collect the Mother’s milk, and when the Doctor says it’s OK to start feeding the baby, then we would give those few drops to the baby. Once the baby is stabilised we then look at fortifying the breast milk.
In my 25 plus years of being in the NICU, I’ve seen this same process: the NICU doctor uses a standard mathematical calculation for calories based on changes within a 24 hour period, and this is what the baby will receive in the volume of the Mother’s milk, including fortification. Maybe the baby is 5 to 7 days out in the NICU, and the baby is not gaining, so let’s give them a 24-Kcal.
OK, then maybe it’s a week, 2-weeks and baby is gaining weight, things are getting better, let’s go down to from 24 to 22 Kcal and if still doing well working towards straight mother’s breast milk. It really comes down to that math calculation of what baby needs in Kcals. Still, it is not taking into consideration the macronutrients of the mother’s breast milk that they are getting, and that is why Preemie is phenomenal!
The soul of that little baby… and each one is different, and we need to look at them as individuals. So yes, the mathematical calculations for fortification work today. However, it doesn’t always provide the proper amount of nutrients needed to individualise the amount for fortification. And, if miscalculated, the baby’s abdomen can become distended as they may not tolerate the amount of fortification given.
To me, Preemie system now gives doctors specific information regarding the macronutrient content within the breast milk, they will also have the option to add other nutrients along with the fortifier such as probiotics. All of this becomes more specific to that particular baby meeting their own personal and individual requirements.
Who knows, maybe we will be able to monitor their intake in such a way that that could affect the long term health of that particular child and decrease interventions and decrease the obesity that happens and other issues that occur in adolescence and into young adulthood.”
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