Transition to at-breast feeding

Oral therapy with own mother’s milk (OMM) – Transition to at-breast feeding interventions

Time to read: 3 min.

The application of drops of OMM to the inside of NICU infants’ cheeks as oral care is considered immune therapy and motivates NICU mothers to initiate pumping early and often and empowers parents’ relationship with their infants

What is oral therapy with OMM?

Oral therapy (also known as oropharyngeal care) is the regular application of small amounts (0.1 – 0.2 ml) of own mother's milk (OMM) inside the infant’s cheeks until oral feeds begin.^1-6

This can be performed from birth:

As regular mouth care for the smallest and sickest extremely low birth weight (ELBW) infants (including those nil per os).^2,4
Every 2–6 hours with enteral feeds.^4,5
As oral stimulation for non-nutritive sucking (NNS).²

Evidence consistently demonstrates oral therapy is safe, inexpensive, feasible and well-tolerated, even in ELBW infants (weighing less than 1000g).^1,2,4

Why is oral therapy with OMM important?

Colostrum and early OMM are high in immunologic, anti-infective and anti-inflammatory factors.{2,7} Oral therapy to date is positively associated with

Reduced risk of clinical sepsis⁴
Inhibition of secretion of pro-inflammatory cytokines⁴
Increase in levels of circulating immune-protective factors in ELBW infants⁴
Support of the reduction in days of total parental nutrition⁸
Support of earlier commencement of enteral and oral feeds^9,10

Oral therapy is considered a form of immune therapy.^2,4-6

Use of OMM via oral therapy has been shown to:

Focus on critical hours after birth

Obtain colostrum for therapeutic oral application
Motivate and sustain the mother to initiate early, frequent pumping and to continue expressing milk.^5,6
Provide parents an opportunity for meaningful participation in their infant’s care, enhancing bonding and promoting maternal confidence.⁶

How to implement oral therapy with OMM

Support the mother to initiate expressing early (within 3h of birth) and frequently ( 8 or more times/ 24h) for own mother’s colostrum.
Commence oral therapy with OMM/colostrum within 24 hours of birth.¹
Administer oral therapy every 2-6 hours until oral feeds commence.
Advocate freshly expressed OMM/colostrum for oral therapy (within 1h of expression).⁶
Teach and support parents to deliver oral therapy to their own infant.
Document administration of oral therapy, as well as any reason for omitting the therapy.

How to monitor oral therapy with OMM

Collect data on daily administration and frequency of oral therapy

Carry out a monthly data review to measure and monitor first use and frequency of oral therapy:

% percentage of eligible infants that receive oral therapy

a) within 24 hours after birth

b) every 2–6 hours until oral feeds commence

reasons for sub-optimal provision of oral therapy

Evaluating infant records on a monthly basis within a quality improvement framework, highlights progress, identifies challenges and supports interventions to improve lactation outcomes.

Downloads

Oral therapy with OMM (pdf)

References

1 Snyder R et al. Early provision of oropharyngeal colostrum leads to sustained breast milk feedings in preterm infants. Pediatr Neonatol. 2017; 58(6):534–540.

2 Rodriguez NA et al. A pilot study to determine the safety and feasibility of oropharyngeal administration of own mother's colostrum to extremely low-birth-weight infants. Adv Neonatal Care. 2010; 10(4):206–212.

3 Rodriguez NA, Caplan MS. Oropharyngeal administration of mother's milk to prevent necrotizing enterocolitis in extremely low-birth-weight infants: theoretical perspectives. J Perinat Neonatal Nurs. 2015; 29(1):81–90.

4 Lee J et al. Oropharyngeal colostrum administration in extremely premature infants: an RCT. Pediatrics. 2015; 135(2):e357-66.

5 Gephart SM, Weller M. Colostrum as oral immune therapy to promote neonatal health. Adv Neonatal Care. 2014; 14(1):44–51.

6 Digal KC et al. Oral care with mother's own milk in sick and preterm neonates: A quality improvement initiative. Indian J Pediatr. 2020.

7 Martín-Álvarez E et al. Oropharyngeal Colostrum Positively Modulates the Inflammatory Response in Preterm Neonates. Nutrients. 2020; 12(2).

8 Nasuf AWA et al. Oropharyngeal colostrum in preventing mortality and morbidity in preterm infants. Cochrane Database Syst Rev. 2018; 9:CD011921.

9 Tao J et al. Effects of oropharyngeal administration of colostrum on the incidence of necrotizing enterocolitis, late-onset sepsis, and death in preterm infants: a meta-analysis of RCTs. Eur J Clin Nutr. 2020 [cited 22-Aug-20]; 74(8):1122–1131.

10 Seigel JK et al. Early administration of oropharyngeal colostrum to extremely low birth weight infants. Breastfeed Med. 2013; 8(6):491–495.

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