NICU - Infant Feeding

At Royal Preston Neonatal Intensive Care Unit, we support that breastfeeding is the healthiest way to feed a baby, especially if they have been born premature or sick. The neonatal team will have a discussion with you prior to your baby being born or following the birth of your baby to discuss  the importance of breastmilk and how to express your breastmilk.

We understand that having a preterm or sick baby is an extremely worrying time and you may not have expected your baby to be nursed on a Neonatal Unit and you may not yet have decided on how you wish to feed your baby.

The following information is to enable you to be able to make an informed decision regarding how to feed your baby through their Neonatal Journey.

Our Neonatal Unit follows the Baby Friendly Initiative programme, and our aim is to provide mothers with information and support to be enable them to breastfeed successfully. We have a Nutritional ward round every week where our team of nutritional experts including our Nutritional lead consultant, Dietician, Speech and Language therapist and Infant feeding team discuss all babies and make a nuritional plan with parents for the week ahead. Our unit is currently working towards BFI accreditation.

All babies benefit from early colostrum. However if your baby is born sick or premature, colostrum is medicine.

Your body produces breastmilk antenatally and from the moment your baby is born even if your baby is born early. On our neonatal unit we aim to provide babies with colostrum within the first 2 hours of life. This colostrum is normally given straight into your baby’s mouth and can be given by parents, as soon as possible after birth. Expressing colostrum within two hours of delivery, also helps to improve long term milk volumes

We will provide you with a colostrum pack on admission

Colostrum is produced in very small quantities but every little drop is precious. It can be collected in a syringe by hand expressing Every drop of a mother’s milk is precious and can be used for mouth care and analgesia.

Colostrum is often called "liquid gold" because of its valuable benefits

• It is high in protein, vitamins, minerals and immunoglobulins (antibodies)
• It builds baby's immune system, helping them fight infections.
• It has a laxative effect which helps to clear meconium  - helping to lower jaundice levels
• It coats your the baby's gut, preventing harmful bacteria and inflammation

Additional useful information about colostrum can be read on the Medela website.

This video explores the amazing science of Colostrum

There are 3 different stages of breastmilk:

Colostrum: Your first milk that lasts between two and four days after birth

Transitional milk: Begins approximately four days after birth and lasts about two weeks

Mature milk: Milk that lasts from approximately 14 days after birth until you are done producing milk

Every drop of breastmilk your baby receives will give them the best possible start in life, to maintain breast milk production the breasts must be stimulated which can be done by hand expressing initially and then carried on by pump expressing.

Read more about expressing here.

You can also read more on:

• Unicef's 'Expressing Milk for your baby in the Neonatal Unit' digital leaflet.

• The NHS's 'Off to the Best Start: Important information about feeding your baby Leaflet'

Babies born prematurely or who are ill face various challenges and it is vitally important that they receive the best nutritional start to help them overcome those challenges. Breastmilk is researched and proven to be the best nutrition that sick and premature babies can receive, especially for premature babies. The preterm infants body is very immature and due to being born early they will not recieve the nutrients and protective substances they would have gained through the placenta during those further weeks of pregnancy. We would like to encourage you to express for your preterm or sick baby even if you do not wish to breastfeed. Please know we support every parents feeding choices.

The composition of breastmilk

• Improved Immunity to fight Infections

• Reduced risk of developing Necrotising Enterocolitis (NEC) a serious gut infection

• Improves maternal mental health

• Supports growth

• Prevents hospital readmissions

• Easy for premature babies to digest and helps their gut grow and mature

• Increased Feed Tolerance

• Tailor made & unique nutrition

• Helps brains to grow and develop

• Promotes unique bonding with your baby

By providing breastmilk to your baby you are choosing to give your baby the ultimate nutrition and the best start that only you as a mother can provide.

More information can be found on the following links:

• Feeding your baby - Maternity services Lancashire Teaching Hospital
• PERIPrem - Early Maternal Breastmilk Leaflet
• You and your baby: Supporting love and nurture on the Neonatal Unit Leaflet (UNICEF)

When a baby is admitted to the Neonatal Intensive Care Unit they may not always be able to initialy have milk feeds or be able to orally feed due to their prematurity or they may be too sick to tolerate feeds. It is important at this time that colostrum is given via buccal (into the cheek cavity) or as mouthcare regularly to give the baby the benefit of these precious golden drops.

During these times nutrition is supplied via intravenous until your baby can start to have milk / oral feeds and often milk feeds are commenced and given by nasogastric / orogastric.

This is one of the reasons we discuss expression of breastmilk as soon as a baby is born so there is a supply of milk ready for when a baby can start to have milk feeds.

Breast Milk Storage and preparation

All milk must be labelled with the baby’s name, NHS number and the date and time milk expressed.

The unit has pre printed labels for each baby, a member of staff will print some milk labels for you.

There are fridges in each room to hold baby’s milk and 2 freezers on the unit.

We use the network guidelines for storage of EBM when your baby is on NICU. These consist of:

Fresh Breast Milk

• Can be kept for 48 hours in the fridge
• Kept in the fridge freezer for up-to 3 months, 6 months in a chest freezer
• Can be kept for 4 hours at room tempertaure

Defrosted Breast Milk must be used within 12 hours of defosting.

Each family has access to one storage box in the freezer and we ask that families take excess milk home to store to ensure all families can use the freezer if required.

When your baby is discharged, please use the NHS storage guidelines.

Breastmilk is warmed up in a special milk warmer before being given to the baby and staff will show you how to use these.

A photo of a milk warmer

Supplemental Feeds

Donor Breastmilk

There may be occasions when mothers own breast milk is unavailable or limited. In these circumstances for the babies that are born premature < 32 weeks and < 1kg or remain sick donor breast milk is used in preference to formula milk for a limited time to protect the babies from gut infections and intolerances.

Mothers donate their breast milk and it undergoes a very strict screening and pasteurisation process. Information regarding donor breast milk can be found here and staff will discuss this option with parents if they feel a baby would benefit from donor breast milk.

Our unit holds a satellite Donor Milk Bank fridge for the North West and donor breast is readily available 

Milk Bank Chester: How it all works Leaflet

Formula Milk feeds with parents consent may be used as a substitute if supplemental milk is required for babies that do not fit the criteria for donor breast milk. The unit has specialist milk feeds for preterm babies and babies with underlying conditions that may require a specific milk to meet their nutritional demands.

Breast Milk Fortifier may be used for preterm and very low birth weight babies who need extra caloric nutritional support to gain weight and growth. Breast milk fortifier is a powdered substance that is added to expressed breast milk and contains extra calories, protein and vitamins.

Nutrition for your baby (BLISS)

During the weekly nutritional rounds babies weight, growth, clinical condition and developmental needs are reviewed and the team will discuss if supplemental nutrional milks could support a baby’s growth and development and will discuss this further with parents.

Increasing breast milk supply

The neonatal staff will support and encourage you throughout your breastfeeding journey and are at hand 24/7 along with our breastfeeding specialist nurses on the unit to help you with ways to increase your breast milk supply.

Transitioning to breastfeeding from NGT feeding

For babies that have been born early or sick, the ability to breastfeed can take time to develop. From around 32–34 weeks, babies will begin to manage sucking, swallowing and breathing at the same time. When having skin to skin contact you may notice early cues from your baby such as opening their mouth, poking their tongue out, turning toward your breast. Letting them lick and nuzzle at your breast is a good way of helping your baby get to know the shape of your breast and smell of your milk. Each feed may be different from the last. By offering them time and support at the breast they will get better, one feed at a time. The nurses will help you with positioning and attachment once baby starts to show feeding cues.

Twins and multiples

The majority of mums are able to produce more than enough milk for twins or triplets without any supplementation. For more detailed information about breastfeeding twins and multiples visit tamba.org.uk.

Supporting breastfeeding mums 

Support from people on the unit is key to successful expressing and breastfeeding. Explain to those around you the importance of expressing and breast milk for your baby and how they can support you. It takes time and energy and mums require a lot of encouragement. Dads and family can help with practical aspects such as helping collect colostrum with syringes, help collecting or cleaning the equipment ready or getting the milk ready for the baby’s feed. Ensuring mum has plenty of fluids and is eating regularly and resting enough.

Bottle feeding

If you have decided to bottle feed your baby, ask the nurses to show you how to offer the bottle in the best way for your baby. The number of feeds may be different to a breastfed baby. However, responding to your baby’s cues for food and love, responsively feeding, having cuddles and providing comfort are equally important. If you are bottle feeding, it is best if you limit the number of caregivers.

Read more: Responsively feeding:Supporting close and loving relationships Leaflet (UNICEF)

More guidance and support with bottle feeding is available below: 

• Infant milks: A simple guide to infant formula, follow-on formula and other infant milks
• Guide to bottle feeding
• How to make up baby formula

Feeding support: https://www.bliss.org.uk/parents/support/useful-organisations/feeding-support

Breastfeeding helplines

National Breastfeeding Helpline - 0300 100 0212 - Lines are open from 9:30am to 9:30pm every day.

NCT Infant Feeding Helpline - 0300 330 0700 - Lines are open from 8am to midnight every day.

La Leche League Helpline - 0345 120 2918 - Lines are open from 8am to 11pm every day.