Case Studies In Breastfeeding Success for Infants with Congenital Surgical Anomalies

Background: Infants born with complex surgical anomalies require extensive intervention, treatment and have high medical care costs both during short term initial hospitalization.  Based on what is known regarding the health outcomes of human milk and the critical needs of these infants, lactation support of the maternal infant dyad must be a priority.  Infants born with complex surgical anomalies require different and more intensive lactation support so that these infants receive the benefits of human milk.  

Case: Five case exemplars will be presented to demonstrate that infants with complex surgical anomalies can achieve breastfeeding success and achieve the recommendations of the AAP

The first case exemplar is of an infant born with congenital diaphragmatic hernia. This infant was on extra-corpeal membrane oxygenation for 32 days.  The mother was successful in maintaining milk supply and transitioning to at breast feeds prior to hospital discharge.  The infant received human milk for its first year of life

The second exemplar is of an infant born with a giant omphalocele.  This mother had an abundant supply (> 1,500 milliliters per day) and fractionated her milk.  This infant successful transitioned to breastfeeding and continues to receive exclusive human milk

The third exemplar is of an infant born with gastrochisis.  The mother is a teen mom who did not wish to breastfeed but decided to pump after a prenatal lactation consultation.  This infant remained in the unit for several months due to adhesions, yet the mother preserved with pumping.  The infant successfully transitioned to breastfeeding prior to discharge and continues to breastfeed.

The forth case exemplar is of an infant with sacrococcygeal teratoma. This infant was born preterm at 28 weeks.  The mother had a failed first lactation experience, only producing <100 milliliters per day.  With intervention, the mother was able to achieve a milk supply of over 400 milliliters per day and the infant received human milk for over 6 months.

The fifth case example is of an infant who was born late preterm and had spina bifida.  This mother with early and frequent pumping, skin to skin care, and non-nutritive sucking was able to provide exclusive human milk for her infant.

Conclusion: Breastfeeding success is possible with even the most vulnerable infants.   Nurses can make the difference in breastfeeding success for these families.

Keywords: Lactation, neonatal intensive care, human milk, skin to skin care, transition to breast