Attention LC's and nurses who assist with breastfeeding

RNIBCLC · Mar 5, 2015

I'll try to do a real search when I'm off my phone a little later. I do remember reading research where preemies have longer length of stay and poorer weight gain when using SNS. I believe I also remember some research on aspiration in preemies getting cup feeding. Probably what this neonatologist is thinking about.
Preemies are just a whole different world. I'm nearly a "lactivist" at work, but the thought of dribbling milk down the throat of an infant with an immature suck/swallow/breathe gives me the chills. Term kids are very different. But by term, I really mean >37-38 weeks.

I agree with you but these are term, otherwise healthy babies. NICU is a totally different arena. Thanks for helping me.

TiffyRN, BSN, PhD · Mar 5, 2015

So there was a Cochrane review of cup feeding in 2007. not of supplemental nursing systems, which I know is what you are discussing. I'm just trying to help you understand why your pedi (who you mentioned is a trained neonatologist) would oppose SNS.

It concluded that cup feeding does not increase the rates of overall breastfeeding at 3 and 6 months of age and delayed hospital discharge by 10 days. So this is legitimate science; however. . .

The problem is with the generalizability of this high quality evidence (meta-analysis is one of the highest levels of the evidence triangle). The studies the author included only involved preterm infants.

So this gives you the appropriate ammunition. Have an official sit-down with this pedi/neo but come prepared with your own set of high quality evidence, evidence that involves primarily term infants; because this is the population of concern for your practice. Be prepared also by having reviewed the evidence he is using; likely this Cochrane review and/or the included studies. Be prepared to explain why the results of this review are not legitimate to change practice on term infants.

Best of luck!!

Flint, A., New, K. & Davies, M.W. (2007). Cup feeding versus other forms of supplemental enteral feeding for newborn infants unable to fully breastfeed. Cochrane Database of Systematic Reviews 2007, Issue 2, Art. No. CD005092. DOI: 10.1002/14651858.CD005092.pub2.

If you don't have access to this, maybe a check with a hospital librarian or a local university library that might let you look it up, at least on campus.

RNIBCLC · Mar 7, 2015

So there was a Cochrane review of cup feeding in 2007. not of supplemental nursing systems, which I know is what you are discussing. I'm just trying to help you understand why your pedi (who you mentioned is a trained neonatologist) would oppose SNS.
It concluded that cup feeding does not increase the rates of overall breastfeeding at 3 and 6 months of age and delayed hospital discharge by 10 days. So this is legitimate science; however. . .
The problem is with the generalizability of this high quality evidence (meta-analysis is one of the highest levels of the evidence triangle). The studies the author included only involved preterm infants.
So this gives you the appropriate ammunition. Have an official sit-down with this pedi/neo but come prepared with your own set of high quality evidence, evidence that involves primarily term infants; because this is the population of concern for your practice. Be prepared also by having reviewed the evidence he is using; likely this Cochrane review and/or the included studies. Be prepared to explain why the results of this review are not legitimate to change practice on term infants.
Best of luck!!
Flint, A., New, K. & Davies, M.W. (2007). Cup feeding versus other forms of supplemental enteral feeding for newborn infants unable to fully breastfeed. Cochrane Database of Systematic Reviews 2007, Issue 2, Art. No. CD005092. DOI: 10.1002/14651858.CD005092.pub2.
If you don't have access to this, maybe a check with a hospital librarian or a local university library that might let you look it up, at least on campus.

Thank you!!! I really appreciate your help.

Jewelsforme · Mar 7, 2015

Hi, my last child did not have a suck/swallow. She remained in NICU first 5 months of her life. She initially had gavage feeding of my pumped breast milk thru NG tube. Prior to discharge she had a Peg tube placed. She also had a trach. But I spent every single day in the NICU while I was recovering from emergency and sloppy C-section. I bled for a year and was oh, so weak. But I managed to provide care in the NICU and became such close friends with the team there. That was 23 years ago and we are still friends with her pediatrician. But to this day, I still cannot walk into an NICU without bursting into tears. I do have some serious PTSD from life, but can work in pretty much any other dept. Hope this baby gets to have her mom's breast milk! I LOVE breastfeeding and lactation teaching.

**canoehead, BSN, RN** · Mar 12, 2015

Ask him for a source for his information, so you can educate yourself. If he doesn't have one, I think you've got your answer. And make sure YOU have sources for your side at any meetings.

Michelle D-J, BSN, RN · Mar 12, 2015

Not sure if this journal article will help or not~Good luck! =D ~MLDJ1970

An Error Occurred Setting Your User Cookie

ABM Clinical Protocol #3: Hospital Guidelines for the Useof Supplementary Feedings in the Healthy TermBreastfed Neonate, Revised 2009

not sure why the link says that, but I found this article on Google Scholar if it ends up not working for you :)

RNIBCLC · Mar 13, 2015

Thank you everyone!! Fortunately this neo has not been on this week so I got a reprieve. But I'm going to have to deal with him next week. Administration loves him so I have to do a political dance while I work on all of this. Wish me luck! I'll keep you posted. I'm getting more LC help next month.