Liquid gold: human milk on the neonatal unit

By Louise Gibson

Screenshot 2019-08-02 at 13.15.18.pngHuman milk is vitally important for vulnerable babies born prematurely; sometimes up to 17 weeks earlier than their due date and weighing as little as 500g. 

New mothers on the neonatal unit are provided with support to express milk for their babies. Often the support to express milk will start before their baby has even been delivered. Very small amounts of concentrated colostrum will be collected first, these precious drops can be collected by a syringe and we refer to this as ‘liquid gold’. Even tiny amounts are packed full of nutrition for the babies and their tiny tummies. 

Human milk is so important as it is specifically made for each mothers baby. The milk changes composition from colostrum to mature breast milk over around 30 days but is continually changing. Premature human milk differs in calories, vitamins and protein from term human milk. Specific antibodies are produced in each mother’s milk to protect their babies. Human milk is shown to protect against illnesses such as necrotising enterocolitis and neonatal sepsis: https://www.bliss.org.uk/parents/about-your-baby/medical-conditions/necrotising-enterocolitis-nec-a-guide-for-parents

These babies have been born so early, missing the 3rd trimester in the womb. The 3rd trimester is when babies grow, lay down protective fat stores and accumulate vitamins. As they have been born before this can occur, premature babies are very small and often lose more weight after birth due to fluid losses. Extra vitamins, protein and calories are required to promote growth.

Premature babies may not yet have a suck reflex and are therefore fed the liquid gold via an orogastric tube (mouth to stomach) or a nasogastric tube (nose to stomach) until oral feeding can be established. 

Within NHS Lanarkshire we encourage and support the use of human milk for all babies. On the University Hospital Wishaw (UHW) neonatal unit we made a video to promote the importance of human milk in this setting. We hope this will raise awareness amongst the whole family from children to grandparents, all staff within NHSL, and the general community of Lanarkshire, and spread the message of human milk as the norm.

Screenshot 2019-08-02 at 13.16.34

If for any reason mothers expressed breast milk is not available or supply has decreased, donor human milk will be used. This is human milk that other mothers have donated to the milk bank Scotland https://www.nhsggc.org.uk/your-health/health-services/milk-bank-scotland/# 

Donor milk tends to be mature breast milk which is lower in calories, protein and vitamins than premature human milk. It contains many of the protective factors of the mothers own milk but is not specific to the receiving baby and thus the baby’s needs. Some of the protective factors are lost during processing of donor milk but this human milk still protects against illness such as necrotising enterocolitis.

Exciting new research has shown that mixing small amounts of mothers expressed breast milk with donor breast milk and incubating will allow bacterial colonisation of the donor human milk to make milk specific for that baby, this is sometimes referred to as seeding. This shows even the smallest amount of liquid gold is greatly beneficial and we are moving forward to implementing this innovative practice. Part of the work I am completing for the NES AHP fellowship is to compile a guideline for the colonisation of donor milk with maternal expressed breast milk.

At times we can proudly say that 100% of the babies on the neonatal unit (UHW) are fed human milk and we are working towards saying it more often! With raised awareness and guidelines outlining the importance of even a few drops of liquid gold I am confident this will happen.

Screenshot 2019-08-02 at 13.17.54

Contact details

Twitter @Gibson80Gibson

Email: louisegibson@nhs.net 

Screenshot 2019-08-02 at 13.16.34.pngMore information about neonatal care can be found at 

https://www.bapm.org/    

https://www.bliss.org.uk/

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