Feeding

Parental involvement

Assisting to feed your baby is a great way to get involved with your baby's care. However, initially your baby may not be feeding due to respiratory problems, surgery or prematurity. Even though your baby may not be able to take milk at first, you will be encouraged to express your milk. Milk can be stored in the milk kitchen by the nursing staff until your baby is ready to feed. If you have decided you do not wish to breastfeed, you may still be encouraged to express your breast milk or permission may be sought to use donor breast milk. Giving your baby breast milk will help to boost his/her immune system, stimulate gut activity, will help to fight infection and is much easier for premature babies to digest.

Nurses and midwives will guide you on expressing milk for your baby, how regularly you should express and how to take care of yourself while expressing. The SCBU is a stressful environment to try and express milk for your baby, but it is the one thing that you can specifically do that is unique for your baby. If you are finding expressing milk difficult or your supply of milk is reducing, there are a few things that could help. Close contact with your baby, including skin to skin contact, will help to stimulate milk production. Express milk by your baby's cot side wherever possible so that you can see and smell him/her. Have a photo of your baby if you are expressing outside the nursery, as well as a muslin that has been close to your baby so that you begin to recognise your baby's individual smell.

> La Leche League GB Breastfeeding Support and information

Tube feeding

Babies who are well enough to begin taking milk, but are still requiring some breathing support, as well as premature babies who cannot co-ordinate sucking, breathing and swallowing, will begin by having tube feeds. A tube will be passed through your baby's mouth (orogastric tube) or nose (nasogastric tube) and straight into the stomach through which feeds can be given. Your baby may be started on a very small amount of milk initially, which will slowly increase as he/she tolerates. Once you feel confident you can begin to assist in tube feeding your baby. Staff will encourage and support you as you learn this new process, but assisting with feeds will help you bond with your baby and feel involved in his/her care.

Breastfeeding

When your baby is well enough and can co-ordinate sucking, swallowing and breathing, which usually occurs after 34 weeks gestation, you can begin to put your baby to the breast. When you first put your baby to the breast he/she will probably not latch on and feed, but may just nuzzle and enjoy being close to you while familiarising him/herself with your smell. This is perfectly normal, especially for babies who have been born prematurely, have been unwell and tire easily. Milk will be given to your baby via his/her naso/orogastric tube until he/she becomes proficient in breastfeeding and medical staff are sure that enough fluid has been taken at the breast. Other methods of encouraging breastfeeding include:

place a muslin that you have had close to you/slept with inside your baby's incubator so that he/she can begin to become familiarised with your smell.
place a used breast pad inside your baby's incubator so that he/she will become familiar with the smell of your milk.
use expressed breast milk to clean your baby's mouth instead of sterile water.

Bottle feeding

If you have chosen to bottle feed your baby, this can begin to be initiated once your baby is well enough, not requiring breathing support, and can co-ordinate sucking, swallowing and breathing, usually after 34 weeks gestation. Special teats are used for premature babies that hold smaller amounts of milk. At first your baby may not take enough milk, and may get tired easily. This is perfectly normal for babies who have been born prematurely or have been unwell. If your baby fails to finish the volume of milk, then this can be given as a 'top-up' via a naso/orogastric tube. This is nothing to be concerned about while your baby practices this new skill and masters the art of sucking, swallowing and breathing to become proficient at feeding.

Milk kitchen

Whilst your baby is resident on the NICU/SCBU in Cambridge you will be

encouraged to express your breast milk ( EBM).

The feeds will be prepared on a 24 hour basis by one of the nursery nurses.

Breast milk can be kept in the fridge for 24 hours. Any breast milk that is over 24 hours old can be frozen in the milk kitchen, and can be kept deep frozen for up to a period of 3 months.

We also have a donor breast milk bank.(DBM). There are only 13 of these in the country. This enables us to give breast milk to those babies that are very premature or sick whose mothers are unable to produce enough EBM for their requirements. All our donors are required to have blood tests and their milk is pasturised before use.

Some of the babies on NICU may need some additional supplementation to their feeds in order to promote adequate weight gain. This can be in the form of breast milk fortifiers or by introducing some preterm formula called nutriprem 1.
DBM and formula milk is only given with the parents consent.

Once your baby is nearing full feeds (not needing intravenous feeding) he will be commenced on some vitamins. These will be given until the baby is either on a very good solid diet or until he is a year old. You will be encouraged to give these yourself on SCBU under the guidance of the nursing staff.

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