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Bayi Prematur ( perawatan & ASI eksklusif )

From: indra cahyanto
To: sehat@yahoogroups.com
Sent: Thursday, January 19, 2006 3:16 PM
Subject: [sehat] Bayi Prematur ( perawatan & ASI eksklusif )

Dear SP's

Mohon share-nya atau mungkin ada yg punya artikel
tentang perawatan bayi prematur.
Anak kami lahir prematur ( usia kandungan 34 minggu ),
karena diketahui ada solusio plasenta.
Saat ini baby-nya masih diruang perawatan ( inkubator
) untuk pemulihan.
Mungkin ada SP's lain yg punya pengalaman dengan bayi
prematur, mohon bagi-bagi pengalamannya.
Mudah-mudahan, pengalaman2 yang diberikan dapat
membantu utk menyemangati kami ( terutama ibunya ),
dalam merawat si kecil, terutama dalam usaha untuk
memberikan ASI eksklusif.

Terimakasih & maaf kalau topik ini sdh pernah dibahas
sebelumnya.

wassalam
abu_filzah

Jawab :

From: suita dian
To: sehat@yahoogroups.com
Sent: Thursday, January 19, 2006 3:45 PM
Subject: Re: [sehat] Bayi Prematur ( perawatan & ASI eksklusif )

Abu Filzah dan istri  yang sedang berbahagia dengan new baby nya, ini sejumlah artikel ttg premature baby n breastfeeding
Banyak sekali artikel tentang bayi prematur Pak, ini hanya sebagian kecil saja.
Ada juga web khusus ortu dengan baby premature (www.preemie-I.org)
Yang jelas dr sejumlah artikel yang saya baca, konklusinya tetep says, " ASI is the best".
Smoga baby nya sehat slalu.....

Dian

Breastfeeding your premature baby  A Preemie-L FAQ
by Justine Diamond and Anne Casey  For most new mothers, breastfeeding is something you expect to happen as a natural result of childbirth. When a baby arrives prematurely, you are suddenly thrust into a critical life and death situation. Your baby will be rushed off to intensive care to be hooked up to breathing tubes, IVs and monitors. You may not be able to touch or hold her. The baby's immediate care seems to eclipse every other concern and thought you may have had. So now you may ask, with some concern "Can I still breastfeed my baby?"

Yes, you can. There are many good reasons for supplying your baby with breastmilk. It is something that only you can do, and it enables you to take a more active role in the baby's care. The breastmilk of mothers who deliver prematurely is ideally suited to the special needs of the premature baby. Colostrum and breastmilk contain white blood cells, antibodies and other valuable immune properties that may help a premature baby resist infection. Recent studies have shown that breast milk may improve the neurological development of premature infants.

It isn't easy. Supply can be very difficult to build up and maintain. You'll need to use a breastpump until your baby is mature enough for direct breastfeeding, and sometimes for longer. Here are some basic questions and answers to help get you started while your baby is still in hospital:

1. When can my premature baby begin to breastfeed?

If your baby is stable and relatively well, breastfeeding can be gradually introduced from about 32-33 weeks. Before this stage, expressed breastmilk can be given to your baby via a gavage tube, and baby's interest in breastfeeding encouraged by the skin-to-skin contact of kangaroo care.

2. How do I get started?

You'll need to begin expressing by the day after your baby's birth, and even earlier if possible. Some mothers prefer to begin with hand expressing. A nurse or lactation counsellor should show you the proper way to express either by hand or with a breastpump. Once your milk has come in, you'll need to begin using a good breastpump. The pump may feel uncomfortable at first, so try to use a low setting. In time, you will be able to increase the speed and the suction setting of the pump.

3. How often and for how long do I need to express?
For the first day or two, before your milk comes in, you'll should pump for about 5 minutes every three hours during the day, and once during the night. Once your milk comes in (no matter how small the amount produced ), you should try to express at least 6-8 times in each 24 hour period, for as long as it takes to completely empty your breasts. You'll need to rent or buy a hospital grade electric breastpump to use at home.   Frequent pumping can be difficult to manage with a sick baby but will help to build and maintain your supply. If your baby is in hospital for a long time, you may decide that it would be better for you to sleep through the night, but try to never go longer than 8 hours without expressing. When you know your baby will soon be coming home, you can begin begin expressing during the night again.   4. What is the best way to store and freeze/thaw milk?
Some hospitals don't allow the use of frozen milk. Your NICU will be able to guide you on their practices and procedures, however these general guidelines should help:

Containers used for collection or storage of breastmilk should be clean and sterile. Most hospitals supply sterile containers or bottles, or small bottles of sterile water (discard water) which can be used to store breastmilk. Small plastic bags or disposable bottle liners (double bag) can be used to freeze milk. Some of the breastpump manufacturers make bags specifically for the purpose of storing milk though these can be expensive.

You need to label each collection with your name and the date, as the oldest milk will be used first. It is safest to refrigerate or freeze milk promptly after pumping. Fresh milk can be refrigerated and transported on ice to the NICU. Many NICUs have a refrigerator or freezer where you can store your milk. Make sure that you don't overfill any bag of milk that will be frozen as the milk will expand in the freezing process.

Storage times: Recommendations provided by The Nursing Mothers Association of Australia   Fresh milk(6 hours at room temperature), refrigerator (3-4 days, at the back of the fridge where it is coldest), freezer compartment of your refrigerator (2 weeks), if the refrigerator has a separate door (3 months), deep freezer (6-12 months).   Frozen milk : if thawed in the fridge but not warmed (4 hours or less at room temperature), thawed in the fridge (24 hours but don't refreeze), thawed in warm water (only for the duration of the feed, or back in the fridge for a maximum of 4 hours).

To defrost: Thaw under warm running water or in a tepid water bath. Do not use hot water, as this can destroy some of the milk's benefits. Do not thaw by leaving on the counter for a long period of time (the refrigerator is O.K. though). Do not microwave breastmilk to heat it or thaw it. Breast milk also separates, so gently swirl to remix

.

5. Is there anything I can do to increase my supply?
Maintaining a breastmilk supply without a nursing infant is very difficult. Here are some suggestions from Preemie-L mothers:
A. Fluids and rest
The stress and fatigue that come with having a premature baby can be counter-productive to your milk supply. A good diet and plenty of fluids are essential, and need to be planned for as best you can. If you find your supply is dwindling despite your best efforts, try to spend a day or two in bed, getting up only to eat and express.   B. Increase frequency of pumping
Most women find that frequent shorter pumping sessions work better than longer ones spaced further apart, for example, 10 minutes every three hours rather than 20 minutes every four hours. You need to experiment and find out what works and what is practical for you. If your baby is still in the hospital, you may not have the opportunity to express freqently.   C. Herbal and Medicinal preparations
There are various herbal remedies that are popular and worth trying (but not all at once!). These include brewer's yeast, fenugreek tea or capsules, blessed thistle (also called milk thistle) and mother's milk tea (a U.S. product). These are usually available at health food stores. A Guinness stout in the evening is also a popular remedy, at the very least it is nutritious and will help you sleep.   There are also medicines which can help your let-down such as Metoclopraminde, available as Reglan in the U.S.A. and as Maxalon or Pramin in Australia and England. The lactation consultant at your hospital can advise you on these. They aren't suitable or effective for everyone.   D. Expressing techniques
Many Preemie-L mothers have found that warm compresses and breast massage prior to pumping helped them to relax, and that this in turn resulted in a higher yield of milk. Stopping several times during pumping to reposition the pump cones can sometimes help. Alternating hand expression with machine pumping during a session may also provide a greater yield. If you are not using a double pump, this is something you should consider.   E. Have your breastpump checked
This is so obvious that many times it is overlooked. Make sure that your pump is working correctly and that the suction is correct and the gaskets are all tight. If there is a problem, you can usually return the pump or get new attachments.   F. Supplemental Nursing System [SNS] (only if you are actually Nursing)
A supplemental nursing system may help increase your supply because it allows your breasts to be stimulated while the baby is fed either expressed breast milk or formula. There are two widely available models the Lact_aid Nursing Trainer and the Medela Supplemental Nursing System. A SNS consists of a bag or bottle that hangs around your neck and is filled with formula or expressed milk. Thin tubes taped to your breasts with surgical tape deliver milk to the infant as he sucks. They can be fiddly to use but some mothers have found them to be a good solution for low supply.

6. What can I do if my baby fails to thrive?
If your baby fails to gain weight, it may be recommended that you supplement your nursing with formula or your milk may be enhanced with a fortifier. This does not mean that you have failed, and it does not necessarily mean that you must give up your efforts to breastfeed your baby.   7. Can I supplement breastfeeding with bottles?
If your milk supply remains low, you can continue to breastfeed with supplements of formula or EBM. Supplemental feedings can be given by bottle, supplemental nurser, cup or by one of the special feeding devices. Depending on the health of your baby, your neonatolgist may prescribe a higher calorie formula, or have a breastmilk fortifier added to your expressed milk. Remember that any milk you can supply, no matter how little, is a precious gift, one that only you are able to provide.   8. What can I do if my baby is unable suck well?
Some premature babies never learn to suck well, even though they may be growing and developing in other ways. You can continue to provide breastmilk for your baby by expressing and giving EBM in bottles. A good routine is to feed your baby EBM from a bottle, and then express for the next feed while your baby is close-by. It sounds awkward but it's actually nice (and time-saving) to combine feeding and expressing this way rather than separating the two activities.   9. Will my baby suffer if I give up trying to breastfeed?
No, your baby won't suffer if you are unable to provide breastmilk. Sometimes, even with the best of intentions and the best of efforts, supply just does not increase. It happens more frequently than the books and the lactation specialists would have you believe, and it is NOT an indication of failure. Milk supply is not a simple equation, especially with a premature baby. The stress of having a premature baby, your own physical condition as a result of the birth all come into play as well as how quickly you are able to actually nurse, and how soon after the birth you are given access to a pump.   While it is possible to build a supply through exclusive pumping, it is very difficult, and most women will experience a decrease in their supply after about 6 weeks of exclusive pumping. Sometimes this can be overcome, and sometimes it cannot.   10. Is there anything husbands can do to help?
For mothers struggling with the demands of pumping, a husband's support is very important. Husbands can help by encouraging rest, shopping for food and cooking, providing companionship during the endless breastpump sessions, offering backrubs, borrowing magazines and videos to help make the time spent expressing more tolerable.   And remember to praise. Expressing milk for months on end can feel like a thankless task. Husbands who nurture their wives through this long and demanding process are helping to provide their premature babies with a unique gift of love.   Sometimes it becomes clear that breastfeeding isn't working out. This can be devastating for a mother who has always hoped to breastfeed, and the love and support of a husband can be a great comfort.   11. When should I wean my baby?
The simple answer to this is when you are ready. It may be when the baby is several months old (or younger) or several years old. As your baby grows, breastfeeding continues to be a source of comfort as much as nutrition. This is part of a unique relationship which can continue as long as you and your child enjoy it, regardless of the amount of milk provided.     Recommended books:   Neifert, Marianne, Dr. Mom's guide to breastfeeding Penguin Group, 1998. Excellent information on breastfeeding high risk infants. A good source for information on increasing supply. One of the only books to address the emotional concerns of not being able to supply an adequate amount of milk.   Eiger, Marvin S, and Olds, Sally Wendkos The complete book of breastfeeding Workman Publishing,1987. Excellent section on expressing and storing milk.
Premature babies

Welcome to your unique premature baby. Congratulations on choosing to breastfeed your premature baby. Breastfeeding provides your baby with the very best start.
Benefits of Your Special Breast Milk
Breast milk provides many benefits. Your premature breast milk is different than milk for a term baby. Your milk is uniquely tailored to your baby’s needs.
Benefits of premature breast milk:

More proteins

Proteins are more easily digested

Higher fat content

More calories

More sodium, iron, and chloride

Decreased risk of allergies

Fewer infections

Increased eye and brain growth

Better weight gain

Getting ready for Breastfeeding
You have a special role in providing your baby with the best nutrition. Some babies are not ready to breastfeed at first. Your baby may need additional support such as tube feedings or intravenous fluids initially. Until your baby is ready to breastfeed, you need to stimulate your milk supply.
We will help you get started stimulating your milk supply as soon after your baby’s birth as possible. Any milk you express is important for your baby’s health. Your baby will be given the milk when the baby is ready to feed.
Different ways you can express your breast milk are:

Hand expression

Hand breast pump

Electric breast pump

The length of time you will need to express your milk will vary. Please speak to your nurse or lactation consultant about milk expression and storage.
Kangaroo Care
You and your baby may also benefit from kangaroo care. Kangaroo care means placing your baby upright, dressed only in a diaper, between your breasts on your bare chest. You may also hear this referred to as skin-to-skin care. This can be done for as little as 30 minutes to as long as 3 hours. Make sure your baby stays warm by covering the baby and yourself with a blanket.
Benefits of Kangaroo Care:

Increases milk supply

Earlier feeding at the breast

More successful breastfeeding

Earlier discharge from the hospital

Stable heart rate and breathing

Increases bonding

Better tolerance for noise and stress

Conserves your baby’s energy

Encourages non-nutritive sucking

Please speak to your baby’s nurse to see if your baby is ready for kangaroo care.
Father or partner can also give skin-to-skin care to promote bonding and baby’s health.
Non-Nutritive Sucking
While you are giving kangaroo care, your baby may start to move toward the breast and find your nipple. Your baby may lick or suck on your nipple. This is the beginning of breastfeeding behaviour. "Non-nutritive"* sucking is rapid and irregular sucking which gets your milk to flow.
In addition to sucking on the breast, babies may have non-nutritive sucking on objects such as the feeding tube, your finger, or the baby’s fist.
This sucking helps the baby to:

Awaken

Get ready to feed

Learn how to suck, swallow, and breathe at the same time

Calm down

Gain weight by helping in digestion

How will I know when the baby is ready to feed?
You know your baby is ready for breastfeeding when you see these cues:

Sucking on hands and fingers

Rooting - searching for the nipple

Mouthing

Licking

Sticking his/her tongue out

Staying awake for short times

These are called ‘readiness cues’.
Premature babies rarely cry when hungry. They may whimper, be fussy or irritable.
It takes energy for your premature baby to breastfeed. It can take up to 40 minutes for your baby to feed. You can expect your premature baby to have a weaker suck, spend less time sucking, and take frequent breaks. Because of this, baby may only suckle well for 5 to 15 minutes or less. If your baby shows signs of being tired, the two of you may need to take a break.
Here is how you will know that your baby is getting tired:

Changes in breathing

Changes in skin colour (pale, mottled or "blotchy" looking)

Squirming

Hands in front of face

Hiccoughs

More spitting up

Breastfeeding
Some babies will be able to breastfeed sooner than others will. This will depend on your baby’s:

Health

Weight

Gestational age

Readiness cues

Ability to tolerate milk

Ability to maintain his/her temperature

Ability to suck, swallow, and breathe at the same time

Most healthy premature babies are often ready to breastfeed before they are ready to bottle-feed. This happens at about 32 weeks gestational age.
Your baby may find it hard to breastfeed if the room is too stimulating. Try to feed in a quiet, dimly lit room. This helps your baby focus on breastfeeding. Use soft voices, whispering, gentle touching, and keep your movements to a minimum
Most babies start on scheduled feeds (every 3 hours) and then progress to ‘demand feeding’. Demand feedings usually start when the baby shows clear readiness cues. It is important the baby feed at least 8 times in 24 hours with demand feeding.
Benefits of demand feeding:

Baby enjoys longer periods of rest (extra rest helps with healing and development).

Baby develops more natural awake and sleep patterns.

Baby learns to communicate those hunger cues to parents.

Breastfeeding is more successful.

The time from the beginning of one feed to the next will vary from 2 to 4 hours. Your baby may spend varying amounts of time at the breast. Take note of how your baby suckles at the breast while breastfeeding. Is it non-nutritive or nutritive?
Non-nutritive sucking
During non-nutritive sucking, the baby may latch on to the breast or may lick, sniff, and/or suck at the nipple and come off. This pattern may be repeated. With this type of sucking, the baby does not receive any milk.
Nutritive sucking
When your milk starts to flow, your baby’s sucking pattern will change to "nutritive" sucking. The sucking will become slower with a more regular rhythm. You may see and/or hear swallowing at this time. You may notice that during sucking, your baby’s ears may wiggle. With this type of sucking, the baby receives milk from your breast.
Your baby will take frequent short pauses during the feeding. With long pauses or if baby starts to fall asleep, you can encourage baby to continue to feed by gentle stimulation.
Remember that both types of sucking at the breast helps you make more milk for the baby.
Breastfeeding positions
Most mothers of premature babies find certain positions for breastfeeding helpful. We have included these here.
To help your baby suckle at the breast, you may find it easier to support your baby’s chin with your index finger.

Football hold

Transition/modified cradle hold

Understanding Your Baby
It is important to learn your premature baby’s behaviour. Because your baby has less energy than a term baby does, behaviour is often subtle and may go unnoticed.
Premature babies spend a lot of time sleeping. They are more difficult to awaken and do not stay awake for a long time.
Learn when your baby is alert and ready to feed and interact with you.
Here are the cues that tell you your baby has fed well:

Baby is feeding at least 8 times in 24 hours.

Nutritive sucking at the breast for at least 20 minutes.

You can see or hear swallowing during breastfeeding.

Your breasts are full before feeding and soft after feeding.

Baby is content after feedings.

Baby has 4 to 5 wet diapers in 24 hours.

Baby has 2 to 3 bowel movements in 24 hours.

You should see these cues after 72 hours from time of birth.
Depending on how well your baby suckled at the breast, the baby may need extra milk. We measure your baby’s weight daily to check for changes in weight up or down. From this measurement, we adjust feeding amounts with additional milk as needed.

This milk may be given by:

Cup

Syringe

Dropper

Finger feeding

Supplemental nursing system

Feeding tube (gavage feeding)

Bottle

Going Home
Your baby is ready to go home when the baby can:

Keep warm in a cot or a crib

Take all of his/her feeding by breast and/or alternate method

Gain weight daily

From: Christina RM
To: sehat@yahoogroups.com
Sent: Friday, January 20, 2006 9:15 AM
Subject: RE: [sehat] Bayi Prematur ( perawatan & ASI eksklusif )

Dear Pak Indra,

Saya ingin share pengalaman teman saya, anaknya kembar dan harus
dilahirkan premature 36 minggu karena kondisi ibunya yg tidak
memungkinkan, sejak dari awal kehamilan air ketuban sering rembes dan
harus bed rest.

Berat lahir kedua anaknya berbeda, yg satu 2,8 kg yg satu 1,5 kg. Dan
anak yg berat badan lebih besar mengalami kelainan jantung bawaan, namun
Tuhan berkehendak lain, setelah operasi jantung, anak yg besar kembali
ke pangkuanNYA.

Namun yg kecil diijinkan oleh Yang Maha Kuasa utk dibesarkan kedua orang
tuanya smp sekarang. Sejak lahir mmg ditempatkan di ruang perawatan
khusus dan si kecil blm bisa minum dg baik shg ASI ibunya harus
dimasukkan melalui selang yg ditaruh di dlm mulut. Tiap hari dipantau
perkembangannya. Setelah bisa minum dg baik maka si kecil boleh pulang,
bukan berdasarkan berat badan. Nah, waktu bisa minum dg baik berat
badannya sdh mencapai 2,2 kg.
Sekarang si kecil sdh di rumah, sdh pinter minum ASI langsung dari
ibunya :)

Tetap semangat ya Pak, selalu berdoa mohon kekuatan dariNYA.
Walau ada di dalam ruang perawatan, selalu dijaga, diajak ngobrol,
dibelai sayang...

Belai sayang buat si kecil,

Tina
Ibunya Elang

From: Masiatun Abdulhadi
To: sehat@yahoogroups.com
Sent: Friday, January 20, 2006 1:22 PM
Subject: RE: [sehat] Bayi Prematur ( perawatan & ASI eksklusif

Dear pak Indra
Mau sharing pengalaman pribadi, kedua anak saya juga lahir premature,
padahal dari kedua kehamilan saya baik-baik saja( dari segala jenis
test, dari mulai urine, darah, dll, semua normal tak ada kelainan walau
mengalami pendarahan ke dua-duanya)
Yang pertama lahir saat kehamilan 32 minggu (7 bln)dengan BB 1.9kg/40cm,
sempat di incubator selama 17 hari, karena saat itu bayi belum bisa
mengisap, jadi ASI di pompa dan di masukkan dengan selang melalui hidung
:-(
Setelah bisa menghisap bayi saya bawa pulang dengan BB 2,050kg.
Tapi anak ke dua lahir saat kehamilan berusia 36 minggu dengan BB
3,5kg/50cm, karena BB sudah mencukupi, tidak perlu di incubator.
Di rumah saya rawat seperti bayi normal biasa, tak ada perawatan
special.
Memang catch up pertumbuhannya agak sedikit lambat, tapi Alhamdulillah
mereka tumbuh dengan baik.
Sekarang anak pertama sudah 6,11th dengan BB 34kg/125cm (ndut!), dan
yang kecil 1,11th dengan BB10,7kg/85cm (standar)
Semoga pengalaman saya ini bisa menenangkan hati istri bapak, dan
permintaan saya agar istri bapak jangan terlalu sedih dan stress, karena
akan mempengaruhi kelancaran ASI.(ini terjadi pada anak pertama saya,
saya terlalu sedih dan selalu menangis memikirkan anak saya yang keecil
sekali, ASI Cuma keluar selama kurang lebih satu bulan, setelah itu
kering dengan sendirinya, walau sudah di tunjang dengan makanan bergizi
dan sayur2an)
Menurut dokter laktasi saya otak mempengaruhi kelancaran ASI.
Semoga pengalan saya ini membantu, maaf kalau tak berkenan.
Salam buat istri tercinta, semoga ASI tetap lancer
Salam
Ibunya Hana

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January 19, 2006 - Posted by | Q&A/ Sharing ASI

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