INTRODUCTION:

“Breast feeding is not a choice. but a responsibility; not just of the mother. but of the society”.

The SNS container can be filled with pumped breastmilk. donor milk. or with infant formula.

The tubing is usually attached with removable tape. When the newborn infant suckles on the breast. the infant is nourished both by fluid from the capillary tube and by the mother's breastmilk from the nipple. The mother's milk supply is stimulated by the infant suckling. and in most cases the use of the SNS can be discontinued in a few days or weeks when the mother's milk supply has risen to meet the infant's needs. Mothers usually obtain SNS supplies from a lactation consultant.

An SNS may be recommended for a mother to use by a lactation consultant for specific reasons concerning the baby. or reasons concerning the mother.

There ’s a lot of reasons a mom might choose to use SNS to feed her baby. Here’s a few scenarios:

Ø Baby is having an issue with latch.

Ø Premature baby

Ø Baby has a cleft lip or palate

Ø Baby born with Down Syndrome

Ø A mother adopting a child who either wishes to induce lactation or create an intimate bond by breastfeeding their baby

Ø A mother who has had previous breast related surgeries. including augmentation. reduction. or removal of breast tissue for medical reasons. or a mother who has insufficient glandular issue

Even mothers with intention to exclusively breast feed are not able to achieve their goals due to lack of support from hospital staff. About 1 in 3 mothers start supplementing their baby in hospital. Infant formula usage in hospital is the biggest predictor of cessation of exclusive breastfeeding post hospital discharge. The “Baby Friendly Hospital Initiative” describes the ten steps for providing support to mothers for establishing successful exclusive breastfeeding.

Mothers are maximally receptive to breastfeeding education during their initial hospital stay. It will be an optimal opportunity for doctors and nurses to educate mothers about breastfeeding positioning. latching. identifying breastfeeding problems and offering customised solutions and suggestions. Parental concerns and choices can also be addressed. and they can be guided adequately. If a mother is having trouble getting breast feeding to a good start. or if she develops breastfeeding problem after she has been feeding for a while. it is important to get breastfeeding back on track as soon as possible.

MATERIAL AND METHODS

In our hospital. (SRH) we have a team of dedicated “Breastfeeding counselling nurses”. who with the guidance of Obstetricians and Paediatricians. counsel the mothers on daily basis regarding breastfeeding. They provide an opportunity for all mothers to discuss their simple doubts and problems with breastfeeding. It also offers a continuity of care. as the same nurse talks to them repeatedly. The nurses and doctors form a closed loop team where each one offers feedback to the other. Apart from teaching mothers about breastfeeding techniques. they also help in managing problems like breast engorgement. mastitis. sore or cracked nipples. thrush and low milk supply.

One difficulty felt in promoting exclusive breastfeeding is when infant formula is introduced due to medical reasons. Prematurity. neonatal hypoglycaemia (which is quite common in infants of diabetic mothers. which again is on a rise). dehydration. severe jaundice are the major conditions which make the Pediatric team prescribe infant formula supplementation. These infant formulas are given to babies using cup. spoon or paladai in hospital. We do not use feeding bottles for such babies. The drawbacks for infant formula feeding by other methods like bottle. spoon. cup or paladai has its own drawbacks.

1. The baby learns an easier way to feed. be it bottle or spoon and starts refusing to suck at the breast.

2. The mother gets less stimulated as baby starts refusing to feed her milk secretion go even low by negative feedback cycle.

3. Baby’s contact and attachment with his/her mother is compromised as other family members take over the responsibility of supplemental formula feeding.

4. Mothers develop a feeling of guilt and start feeling demotivated.

5. Supplemental feeding tube method or Supplemental Nursing system (SNS) It is a simple technique of on breast supplementation or an alternative feeding tool. It enables mothers to get the feel or breastfeeding. trains the baby to suck. It is a simple system consisting of a disposable syringe and a thin calibre feeding tube (5F). the end of which is cut short and stuck close to the nipple. The baby is made to latch on the breast and the feeding tube together and milk is let down slowly as baby sucks naturally. (Figure: 1).

Figure 1a: SNS with bottle (for bigger babies). where baby must actively pull the milk.

Figure 1b: SNS with syringe and piston: where milk is manually pushed by a nurse; for preterm neonates in NICU.

Figure 1 c: SNS with passive flow of milk through syringe. with nurse controlling only flow by kinking the tube.

Figure 2: A term baby (left side image) and a preterm baby with nipple shield (right side image) feeding through SNS.

The Supplemental feeding tube method is an ideal way to administer supplemental nutrition to babies while they are doing simple act of breastfeeding (Figure 2). This system supports unique bond between mother and baby motivating both of them to move towards a more satisfying breast-feeding experience. Through this baby can get additional milk they require without interrupting or interfering with breastfeeding. Supplemental feeding tube method additionally helps babies who have breast refusal. It is also preferred by few surrogate mothers and adoptive mothers. It increases breast milk production as baby sucks calmly for a longer time at breast.

Here’s 6 tips to make an SNS easier

1. Get a lactation consultant.

2. Get your partner on board!

3. Make space

4. Explore the options.

5. If you have milk. use it

6. Give yourself a break.

WEANING:

Prepare:

Talk to baby's health care provider and get his/her input. Record supplement amounts for a few days to determine how much supplement baby is getting per day. Use expressed milk for supplements if available. If you don't have enough expressed milk. add banked milk or formula.

If your baby is gaining weight well. then you might consider offering less of a 'top off' after breastfeeding and see if your baby continues to gain weight well. If your baby is gaining more weight than expected for his/her age. this is also a reason to pull back on supplementation.

RESULT:

We have been offering this supplemental feeding tube method for babies with medical needs for formula. This includes preterm babies who are not able suck vigorously at mother and babies in postnatal and special wards who are with their mother. The system is found to be user friendly.

Consuming less of nursing time. with extreme satisfaction from mothers. It cannot be used when baby does not have any sucking reflex. has respiratory distress and is neurologically abnormal. Mothers’ frequent presence when baby is in NICU and the nursing time consumed is other limiting factors. Milk leaking and wastage is another factor. Slowly we intend to offer this technique for all babies who need supplemental formula.

SNS allows for the exclusive breastfeeding experience. which is not only about providing mother's milk to baby but just as much as about creating an intimate bond. It provides a comforting. safe place for baby and offers the mother and baby a way to feed in the most natural approach.

REFERENCE

1. This article needs additional citations for verification.

2. "Breastfeeding With a Supplemental Nursing System - Breastfeeding Support". Breastfeeding Support. 2014-07-15. Retrieved 2018-02-17

3. Information on SNS for adoptive mothers (Retrieved 2010-07-08)

4. How to use a supplemental nursing system (Retrieved 2010-07-08)

5. Victora CG et al. Lancet. 2016; 387(10017):475–490.

6. Thousand Days; 2019. Available from: https://thousanddays.org/why-1000-days/.

7. Hassiotou F. Geddes D. Clin Anat. 2013; 26(1):29–48.

8. Ballard O. Morrow AL. Pediatr Clin North Am. 2013; 60(1):49–74.

9. McClellan HL et al. Nutr Res Rev. 2008; 21(2):97–116.

10. Ecomall. Available from: http://www.ecomall.com/greenshopping/mbr.htm.

Received on 10.08.2021 Modified on 01.12.2021

Int. J. of Advances in Nur. Management. 2022; 10(1):87-89.

DOI: 10.52711/2454-2652.2022.00022