Anemia of Prematurity - Portal Neonatal

Engorgement
Engorgement is a common breastfeeding problem, and its prevention is important. A mother should be
encouraged to breastfeed several times a day to establish her milk supply and to ensure relief after
her milk has come in. If a mother's breasts are so distended that the nipple is obscured, the infant may
have difficulty in latching on. A mother may manually express or pump her milk to relieve the tension
and distortion of the breast, which makes the nipple to be available for suckling by the infant. The
mother should continue this cycle frequently as her breasts regulate to the requirements of her infant.
Cabbage leaves, either whole or as a minced paste, have been shown to relieve the swelling and pain
of engorgement within 12-24 hours of application. The use of lanolin is not helpful in engorgement.
Recommending that the mother discontinue breastfeeding is not appropriate because breast milk is
the preferred source of nutrition for the infant and because the mother has shown that she desires to
breastfeed with her action of initiating breastfeeding.
Insufficient milk supply
The misperception of an insufficient milk supply is common, particularly with first-time mothers. A
mother who plans to breastfeed should undergo a prenatal assessment to evaluate her breast
development during pregnancy and the condition of her nipples (eg, Are they inverted?) and to discuss
strategies to achieve successful lactation. These strategies include frequent breastfeeding every 1.5-2
hours during the first few days. If a mother does not breastfeed frequently enough, her milk production
is delayed.
The first-line treatment for an insufficient milk supply is to have the mother breastfeed frequently
because any milk removed is quickly replaced. If a mother has been too ill to breastfeed or pump her
milk or if her infant is too ill to breastfeed, the mother may have an insufficient milk supply. Again, the
mother should be encouraged to breastfeed, if her infant is able, or to pump her breasts to stimulate
milk production.
Galactagogues
Galactagogues or milk production enhancers may facilitate milk production. Probably the best known
agent with the fewest adverse effects is fenugreek, an herb used in Indian curries and cooking. It is
well-tolerated by most women. It can be taken as a tea (2-3 cups of tea per day) or as a capsule (two
500-mg caps tid for a total of 6 caps per day). Milk production should increase within 48-72 hours.
Other herbal remedies include fennel seeds brewed as a tea (1 tsp boiled in water and steeped for 10
min, served 2-3 times per day), milk thistle, and goat's rue. Contraindications to these herbal remedies
include the current use of antiepileptic agents, coumadin, or heparin because the herbs may affect
drug levels or clotting parameters.
Medical therapy
Metoclopramide (Reglan) acts as a potent stimulator of prolactin release and has been used to treat
lactation insufficiency. Although the US Food and Drug Administration (FDA) has not approved
metoclopramide for this indication, a dose of 10 mg PO tid has been shown to increase milk
production. An increase of milk letdown response was experienced by as many as 60% of women
within 3-5 days. Limit use to a maximum of 10-14 days. Coadministration of opioid analgesics with
metoclopramide may increase CNS toxicity.
Large trials of galactagogues are lacking. Available data come from small studies and case reports.