Anemia of Prematurity - Portal Neonatal

• Observe the position of the infant's lips on the areola. Typically, the lips should be 1-1.5 inches
(2.5-3.8 cm) beyond the base of the nipple.
• Observe the lower lip. If folded in, suckling does not occur. The lips should be flanged.
• Observe the presentation of breast to the infant and the mother's assisting the infant to latchon.
• Observe the response of the infant to lower lip stimulus. The infant should open his or her
mouth wide to allow the insertion of the nipple and areola.
• Observe the motion of the masseter muscle during suckling, and listen for sounds of
swallowing.
• Observe the mother's comfort level, and ensure that she is not having breast pain.
One should reinforce a mother's own physiologic cues during breastfeeding. A mother's letdown is the
interplay of her physiologic response to suckling and her emotional state. Prolactin, the hormone
responsible for letdown, is inhibited by stress (mediated by dopamine, norepinephrine, and
epinephrine). The mother's relaxation ensures adequate letdown and the continued adequacy of
breastfeeding.
Putting the infant to breast 8-12 times a day during the first 4-5 days after birth ensures the creation of
an adequate milk supply, which the infant's use later regulates. A mother who responds to her infant's
cry with letdown and who breastfeeds her infant on demand (ie, unrestricted breastfeeding) is more
successful with continued lactation than the mother who breastfeeds according to the clock. The
recommendation for mothers to use systematic or controlled timed feedings to help regulate the baby's
cycles is fraught with misinformation. A mother should be empowered to follow the internal schedule
that is appropriate for her and her baby.
FACTORS AFFECTING THE MATERNAL MILK SUPPLY Section 5 of 11
True difficulties in the supplying of milk are most commonly related to the irregular or incomplete
removal of milk. In the human mammary gland, lactation is under autocrine control in which the
frequency and degree of milk removal appears to regulate an inhibitory peptide present in the milk. In
other words, if the milk is not removed, this inhibitory peptide accumulates and subsequently
decreases the synthesis of milk. If the milk is removed frequently, this inhibitory peptide does not
accumulate, and milk synthesis increases.
Although most women are capable of producing more milk than their infants require, more than half of
breastfeeding mothers perceive that their milk supply as inadequate. A mother may state that her milk
is not in and that her infant is not getting enough milk. This misperception is most common during the
immediate postpartum period. The neonate's requirements for fluid gradually increase over the first
few days; ideally, the neonate frequently ingests milk in small volumes. As the baby's GI tract
becomes more regulated and functional and as the stomach volume increases, the baby's milk intake
increases.
The composition changes of the milk from colostrum to mature milk, which has a higher energy
density (ie, caloric density) because of its higher fat content. Mothers should be encouraged to
breastfeed at least 8-12 times during the immediate postpartum period to increase their milk supply. If
a mother breastfeeds only 4-5 times during those early days, her milk production is delayed.
Infrequent breastfeeding is associated with neonatal jaundice (referred to as breastfeeding jaundice or
dehydration jaundice) and the early cessation of breastfeeding. Another perception of inadequate milk
supply is related to the infant's growth spurts. During periods of enhanced growth, the infant may be
more irritable and may seek the breast more often. These growth spurts usually resolve in about 1
week. Growth spurts should be explained to the mother to prevent undue stress or interruptions in
breastfeeding.
Because the milk supply is directly related to its removal and ongoing synthesis, factors that hinder
milk removal affect milk production. Factors that could disrupt the complete removal of milk are
numerous (see Recognition and Management of Common Breastfeeding Problems). For example,