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Chapter 1: How has the feeding of premature babies evolved over the years?
Over the past 30 years, the feeding of premature babies has changed considerably. In the past, medical professionals were hesitant to feed these very small babies, preferring to deliver nutrition via IV fluids. Now, tiny amounts of breast milk in the first few hours of birth is considered liquid gold in helping these infants to grow and develop.
Our reporter Moira Faye has been to the Coombe Hospital where they have established a range of resources to help mothers breastfeed their premature babies. Moira, good morning. Thanks very much for joining us. When we say small amounts of breast milk, how small are we talking?
We're talking a couple of millilitres, David. However, to get those few drops of liquid, it can be very challenging for mothers who have given birth several weeks ahead of schedule for a number of reasons. They may have gone through a traumatic birth.
Chapter 2: What challenges do mothers face when breastfeeding premature infants?
They may have given birth early due to illness. And they may have not had a chance to get to any breastfeeding classes. And to navigate all of that needs a lot of counselling and support. So to help mothers in those situations, the neonatal intensive care unit at the Coombe Hospital has done a number of things. In 2019, they appointed a dedicated lactation specialist to the unit.
Then in May 2024, they appointed a dedicated speech and language therapist. It's a very new and evolving role. It's all about communication when feeding and working on the suck, swallow, breathe pattern to avoid milk going down the wrong way.
Now, for breastfeeding NICU mothers, the Coombe also gives them all the breastfeeding equipment they need so they don't have to worry about going out to buy supplies. And they also get a free meal each day in the staff canteen. And the Coombe is having really good results through these supports.
44% of extremely premature babies born at the Coombe Hospital are exclusively breastfed at the point they're discharged from the hospital. This is well above the average, the Irish average, which is just 11%.
But if you've given birth at 23 or 24 weeks, is it physically possible to produce breast milk?
It is. I.B. Chak is the lactation specialist at the unit and she explained to me the science behind it.
Colostrum starts producing by 16 weeks of pregnancy. So there is milk. And when they deliver 23 or 24 weeks...
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Chapter 3: What resources are available for mothers in the NICU?
It will be always drops, drops of cholesterol, which is liquid gold. It's a life-saving, vital medicine for the premature babies, and it acts like a first immunization. And that little liquid gold is full of antibodies, live antibodies. And usually, we always tell mothers that you won't get huge amount of milk. It will be drops, and that's full of bundle of antibodies.
And as long as they understand that, they'll be so delighted to see the drops. And that will be given to the baby's cheeks, the little like 500 gram, 600 gram babies to the cheeks and the antibodies are absorbed from the cheeks. So that's an amazing benefit of that little colostrum drops.
So when they see that little drops coming to the ICU and giving to the baby, they are so delighted to have the drops.
When you say drops, you're talking about 10 mil, 20 mil?
No, 0.1, 0.2, 0.3 drops, because the babies are 500 gram, 600 gram. And that's a big drop for them. So when the mother understands that they don't need to produce huge amount,
they will be very happy to work on the little drops and once they relax and their health gets better and once once they get into a routine they will establish a very good milk supply and we had like loads of mothers who had babies at 23 24 or 25 weeks they have donated milk to the milk bank even 20 litres, whatever extra they had. So they can produce breast milk, but they need early support.
Lactation specialist Ibi Chak there. But presumably some babies do receive donated breast milk.
They do. For some mothers, their breast milk may not come in because of physical stress or medical complications around an early delivery. And it's also a big part of IB's role to support and counsel those mothers where donor milk is the only option. Now, breast milk is not the only thing premature babies receive. Sometimes an additional fortifier is added to it.
Fiona Dunleavy is the dietitian manager at the Coombe and she explained to me why this is and how many calories a premature baby needs.
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Chapter 4: How does colostrum benefit premature babies?
So every other nutrient would also have similar kind of, that's an obvious one to think of, Protein is obviously very popular. A lot of people think about protein for muscle building or fitness. Protein is so important for babies. So, again, in pregnancy, babies grow rapidly from 24 weeks onwards. And we need to kind of replicate that for our little babies.
And protein is a real key building block. What's really interesting is.
newborn milk particularly preterm milk is higher in protein than milk further out so then more mature milk so we have we have that unique substrate for those newborn babies that premature milk even in the colostrum it would be different to term milk so it's really important to get that milk in for our newborn babies here so we really work hard with the mothers to make sure that they can provide that milk for their little babies
whether they decided before or not to breastfeed, we need to support them to supply the milk because it's so important.
So the human body adapts the milk recipe, let's say, to when the baby's delivered. That's amazing. Yeah, absolutely.
Now, unfortunately... it doesn't adapt it enough. So in fact, we do have to add a little bit of additional. And it's important, I suppose, for any parent or for other people to realise that we add a thing called fortifier. And we try and only add a small amount. It's minute amounts, but it gives the additional protein and additional vitamins that are required for that baby in a safe way.
So it's a kind of a powder that would be actually similar to formula, but formula wouldn't be suitable for these babies. So it's just a similar substrate that we add to the mother's milk or to the donor milk, depending. And we even have a breast milk analyser here so we can analyse the milk to decide how much board of ours. So we're only adding the minimum amount that the baby needs.
That's Fiona Dunleavy, dietitian manager there. And you also spoke to a mother of a baby at the Coombe NICU unit. Tell me their story.
So I spoke to Laura Gorman from Lucan in Dublin. She gave birth to her third baby boy on February 27th. Baby Luke came into the world at 27 weeks and five days gestation, weighing just 1.14 kilograms. I asked Laura how her breastfeeding journey has been so far with Luke.
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Chapter 5: Is it possible for mothers of extremely premature babies to produce breast milk?
It was late on a Friday night. I had my instructions on what I needed to do to help get the golden milk out, which is their cholesterol. I hadn't harvested because it was way too early. And so I hadn't thought about anything like that. And I'd never hand expressed before.
So I had the instructions, I had the tubes to express the syringes and I managed to get some and I was rushing down to the NICU unit when I could to bring the milk because I was just so fearful of how is he going to feed if I'm not there beside him. But everyone, you know, put my mind at ease to say don't worry right now, you know, he was on
different fluids, antibiotics and stuff at that time, and he didn't need a lot. But when I got to give my syringe of cholesterol into his little mouth, although you go into this room and there's medicine, there's equipment, it's very scary, but to see milk that came straight from my breast into his little mouth and him move it around was just...
I can't describe the feeling to know that that came straight from me and it was his medicine. So it was really, really nice. So that was the cholesterol harvesting at the start. And I continued to do that when I was back on the ward. All the equipment was there. Every nurse that would come in would say, would you like a hand? Can I help you? Can I watch you?
To see if you're doing all right, to help you get a little bit more. Because I was so emotional, as you can imagine. And then I was afraid if I stressed too much, would my milk...
come in or would it stop so you've lots of anxieties that go through your mind and but it worked and with there and i got there and i'd bring down my little syringes proudly and the nurses would celebrate as well to say well done mama you know you brought this down this is amazing and and then there was everything then became a little bit easier as i learned and adapted to life in in here oh and how's baby luke doing now
He's just over seven weeks old and Laura and her husband Matthew are delighted with the progress he's made.
I think it was day five or six was when he was on full mammy milk at that stage when he'd been weaned off his fluids and the rounds of the doctors that happen each day, they'd say, look at his growth and that's all you mammy, that's your milk, which made me really, really proud. So he went from, I think he started on nine mils and he's now up to 42 mils of breast milk daily. So that's a big jump.
And when I watch the syringes getting bigger and the milk getting poured in, extra milk to make sure that the exact measure based on his weight, it's just amazing. To do all of that, as a mummy of a premature baby, you have to really think, you know, what do I need? I went into panic mode. I have no breast pump. I have no bottles. I have nothing. Everything is provided through the Coombs.
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Chapter 6: What nutritional needs do premature babies have?
It's only me that can do that for Luke. And how's baby Luke doing now? He's doing amazing. So we've had a really, really good weekend. So he's now 34 weeks gestation. He's just over six weeks old. He has started now moving on to the breast, learning and navigating how to use his little mouth.
So at the start, we do it with an empty breast, and I've had Ivy and Ciara there from Sweet and Language watching, helping, and everything they say has happened, as it should, that he'll start with little licks, you know, little explorations, little sucks.
But it was Thursday last week when we put him on the breast for the first time, and when I felt two or three sucks, my heart just burst, and anyone I spoke to that day, I was like,
Luke latched on today he sucked you know it was just so proud to have breastfed before to know that bond and to remove the pump which is there for its purpose but for him to just be on my breast without having to use any equipment was just incredible so he's doing great so we're going to try a full feed today so this is all great timing um a full feed today um
hopefully he'll manage but we'll navigate and we'll take it day by day to get his feeding and that will be one of our last steps then to get home how are you doing i'm doing good i have my days i go on roller coasters i go up and i go down um but i'm doing really well now but it's been challenging and i i think for any new mammy coming in here i didn't know who to ask i didn't know
I don't want anyone to know this experience because it's tough. But to be able to share and to hopefully help another man meet like is just my little give back. So I'm doing good.
That's Laura Gorman there, mother of baby Luke and lovely to end with a happy note. Maura Faye, thanks so much.
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