To establish lactation when an extremely premature birth occurs, it is important:
1) Manually expressing colostrum, within the first three hours after birth, initiates the milk production process and has several benefits:
- It empties the mammary gland which, together with the action of the hormones that promote labor and delivery, are a powerful stimulus to initiate milk production.
El Código se aplica en todos los países, con independencia de lo establecido en las políticas nacionales sobre la alimentación de los lactantes cuyas madres están infectadas por el VIH. La aplicación del código es fundamental para que no disminuyan las tasas de lactancia materna.
Human milk is the best food for newborns, even if they are small, premature or sick. Breastfeeding improves infant survival, health and development. It is also associated with better neurodevelopmental outcomes and less obesity, hypertension and insulin resistance in adolescence, among many other benefits.
The daily application of chlorhexidine to the umbilical cord stump in the first postnatal week is a recommendation that depends on the settings.
The only scenario that supports its use is where traditionally noxious substances (e.g., animal manure) are used on the umbilical cord. In newborns with unhygienic cord care (defined as the use of noxious substances on the cord, such as dust, clay, mud, and animal manure), chlorhexidine reduced mortality.
Any type of promotion of breastmilk substitutes, bottles and teats should be completely prohibited at health care facilities, as established by the International Code of Marketing of Human Milk Substitutes and subsequent relevant resolutions of the World Health Assembly. In addition, no free or subsidized donations of breast milk substitutes or other products, gifts or samples may be given to health workers at any health system facility.
Regarding the administration of feeding the premature newborns in intensive care areas, the written breastfeeding policy should explicit issues related to the:
If the newborn’s clinical condition is favorable, skin-to-skin contact should be initiated immediately after birth.
The vital signs of mother and baby should be checked regularly to monitor their well-being. The person accompanying the patient, family member, doula or health care staff should monitor the woman’s wakefulness to protect the newborn’s safety in this vulnerable period.
Necrotizing enterocolitis (NEC) is one of the most serious morbidities in preterm infants (PTNB). It is an inflammatory disease of the bowel that can cause perforation of the gut and peritonitis. Its underlying cause would be multifactorial. Some theories blame intestinal mucosal injury, inflammation and the presence of abnormal gut colonization.
Feeding PTNBs with human milk (HM) seems to have a preponderant role in the reduction of NEC, even if the supply of HM is partial.
Interventions to support responsive caregiving during the postnatal period should focus on promoting positive interactions and strengthening the caregiver/infant relationship.
Health care workers should encourage mothers, fathers, and other caregivers to be aware and responsive, responding to the child's needs, cues, clues, behaviors, and desires.
It is important to encourage caregivers to develop skills in the contexts of play, communication and feeding, such as breastfeeding on demand.
It is important to close the gap in the possibilities that women have to breastfeed their children since breastfeeding can act as a factor of equality in society.
Human milk is the best nutrition for children at a time when the epigenetic foundations for health and development are being established. Everyone has the right to access breast milk.
It is essential that no one is left behind, especially vulnerable mothers who may need additional support to reduce inequalities in the ability to breastfeed.