EXPRESSED BREAST MILK (EBM)

EXPRESSED BREAST MILK (EBM)

EBM should be first choice. Milk of the LBW baby’s milk provides higher protein and calories. It is, therefore, not only species-specific but also baby specific on account of its best suitability for the infant. Expression of milk can be carried out by mother’s attendant though mother herself is the best for this purpose. The choice about the manual expression or the use of a breast pump is influenced by the existing circumstances as well as mother’s attitude.

Breast milk expression

First 24 hours

Twice, 2 min at each breast

Second 24 hours

Thrice, 3 min at each breast

Third 24 hours

Four times, 4 min at each breast

Fourth day and onward

Five or 6 times, 5-10 times at each breast

Expression of milk must be done in a safe and clean manner. The concept of human milk banking now gaining popularity in the European countries poses several difficulties in the developing countries because of unfavorable climate, ignorance, illiteracy, impracticability of monitoring of each sample before administration and holder pasteurization. Nevertheless, in view of the greater need for human milk for the LEW infants, the need for modified human milk banking cannot be denied. Expressed milk provides adequate amount of protein, energy, vitamins and copper nearly adequate amounts of zinc, iron and magnesium which , however, are needed in yet greater measure by the LEW baby. It is poor in calcium and phosphorus. Supplementation with these nutrients is, therefore important in the care and feeding of LEW infants.In case enough EBM from the biologic mother is not readily available, it may be collected from another lactating healthy mother.

 

Resort to top milk is indicated only in case of lactation failure despite best of efforts at relactation. It should be for a short period only and breastfeeding resumed as soon as possible.

Nutritional Supplements

Preterm human milk, though superior to pooled term milk, is deficient in iron, calcium, phosphorus, zinc and copper. It provides more proteins and energy but the preterm LEW infant needs yet more of these. EBM, therefore, works better when supplemented with human milk fortifier or individual nutrients. At present, the only available HFM is lactodex-HMF (Raptakos-Bett).

Human milk fortifiers: At 2 weeks of age, human milk fortifier may be added to EBM for providing extra protein, energy and micronutrients. The dose is 2 g of Lactodex-HMF for 50 ml of EBM. The resultant fortified  EBM provides additional 0.2 g protein, 0.19 g fat,

1.2 g CHO plus calcium, phosphorous, vitamins, minerals and trace elements.

Vitamin K: Right at birth, 1 mg vitamin K should be given intramuscally.

Multivitamin drops: Again at 2 weeks, multivitamin (inducing folic acid) drops should be introduced.

Iron: At about 4-8 weeks, low dose (2-3 mg/kg/day) iron supplementation should be started.

Vitamin E, calcium and phosphorus : Supplementation with these micronutrients is recommended, especially in case of VLB W.