Buccal Colostrum Administration for Babies Admitted to the Neonatal Unit

Publication: 13/12/2011  
Next review: 15/02/2025  
Clinical Guideline
CURRENT 
ID: 2807 
Approved By: Trust Clinical Guidelines Group 
Copyright© Leeds Teaching Hospitals NHS Trust 2022  

 

This Clinical Guideline is intended for use by healthcare professionals within Leeds unless otherwise stated.
For healthcare professionals in other trusts, please ensure that you consult relevant local and national guidance.

Buccal Colostrum Administration for Babies Admitted to the Neonatal Unit

Aims

To facilitate and optimise preterm and/or sick infants receiving mother’s own colostrum via buccal administration. To reduce the incidence of late onset sepsis, protect against NEC and support/protect breastfeeding in the neonatal journey and beyond.

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Indications

All babies admitted to the neonatal unit who are too clinically unstable to receive colostrum via any other feeding method, including surgical admissions. Being nil by mouth is not a contraindication to receiving buccal colostrum, instead this population stand to gain from the protective factors of colostrum that they would otherwise be denied.

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Contraindications

Babies who are unable to receive mothers own milk e.g. high viral load HIV mother or mothers on contraindicated medications e.g. chemotherapy.

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Background

Colostrum is milk produced in the first few days after delivery. It is rich in immuno-protective, anti-infective agents and growth factors such as immunoglobulin A, cytokines, Lysozymes, lactoferrin, and epidermal growth factor. Together, these chemokines and trophic agents 5 protect the infant from infection, stimulate the development of the gastrointestinal tract and modulate the immune system, especially in preterm infants.

Colostrum produced by mothers who deliver preterm infants has a higher concentration of immunologically active factors compared to colostrum of mothers who deliver at term gestation. When administered directly onto the oral mucosa colostrum may provide benefits by acting in several ways: by stimulating the oropharyngeal-associated lymphoid tissue system, by systemic absorption of protective factors through the buccal mucosa inducing systemic immune responses, by acting as barrier preventing microbial adhesions to the mucosa, by enhancing the development of the gastrointestinal tract.

Colostrum given orally also allows colonisation of the infant with flora from their mother which helps to reduce colonisation with more pathogenic organisms. Preterm infants are at a particularly high risk of late onset sepsis and necrotising enterocolitis which can lead to death, increased morbidities, prolonged hospital stay, increased cost of care, and worse long term outcomes among survivors. Administration of buccal colostrum in the first few days of life is a safe, feasible, prophylactic measure against sepsis, NEC and ventilator associated pneumonia.

Recent studies have found a higher incidence of prolonged breast milk feeding in infants whose mother’s provided colostrum for buccal administration in the first few days of life. The provision of colostrum also enables mothers to have some control of a highly beneficial intervention at a time when other treatment is highly medicalised.

Administration of buccal colostrum is a practice used to provide the benefits of colostrum to all sick and preterm infants who cannot access oral breast feeds and can be used even in the critically-ill, ventilated, fragile infants. Colostrum is placed in the buccal cavity by a syringe. Colostrum is not swallowed by the infant but it is absorbed locally by the buccal mucosa. This guideline presents a safe and practical procedure for administration of buccal colostrum to sick and preterm infants.

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Administration

All mothers who receive antenatal counselling in anticipation of their unborn baby/ies being admitted to the neonatal unit should be informed about the benefits of colostrum and given a colostrum pack. Colostrum packs can be found on labour ward and the neonatal unit. They should be advised to express antenatally if delivery is expected within the next 24 hours or if not as soon as possible following delivery. The aim is for babies to receive the colostrum in their oral mucosa within an hour of birth.

Antenatal counselling should cover:

  • Administration of buccal colostrum should ideally be initiated as soon as colostrum is available, ideally within an hour of birth
  • Only the mother’s own colostrum should be used
  • Fresh colostrum should be administered when available. Stored colostrum may be used in order of expression if fresh colostrum is unavailable (as per the guidelines for breast milk storage). Avoid freezing colostrum due to degradation of the bioactive compounds – endeavour to give ALL colostrum expressed.

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Steps of administration

All maternal colostrum should be stored and handled as per unit Breast Milk Storage and Handling Guidelines.

  1. Provide mother with labels and sterile containers/enteral syringes for colostrum collection. Colostrum can be collected in appropriately labelled 1 or 2 ml enteral syringes. A colostrum pack contains everything the mother will need.
  2. Whilst adhering to breast milk storage and handling guidelines put a maximum of 0.2 ml of mother’s colostrum in a 1ml oral syringe, cap and label it with infants name, hospital number, date of birth & date and time of expression. At the infant’s bedside, verify that the medical records on the colostrum container match those on the infant’s record chart using a 2 person check method.
  3. Remove the cap of the syringe and gently insert the tip of the syringe into the infant’s mouth along the right side and directed posteriorly towards the oropharynx. Administer a maximum of 0.1 ml of colostrum slowly over at least one minute. Place the syringe along the left side of the infant’s mouth and deliver another 0.1 ml of colostrum by the same procedure. There is no need to turn the baby during this procedure. For babies with their head facing to the side it may be appropriate to give all 0.2 mls into one cheek only. Ensure that the 0.2mls is spread over at least 2 minutes, closely watching and supporting the baby. Pauses may be necessary. Do not use a gauze swab as this will absorb colostrum leaving little to be absorbed by the infant. Do not use a gloved finger as this inhibits the ability to accurately measure the volume the baby receives and could create a negative oral experience for the infant.
  4. Avoid oral suction for 30 min
  5. Monitor the vital signs of the infant throughout the procedure.
  6. Repeat the procedure every two hours for the first 48 hours. Liaise with maternity services to provide prompts to express when mothers are not clinically stable enough to visit the unit.
  7. Record the procedure on the infant feeding record chart.
  8. If feeds are commenced, the oral colostrum should be given first and then the OG/NG feed. Oral colostrum volumes should be recorded separately and not included as part of the feed volume.
  9. Record any adverse effects on the chart and in the medical notes.
  10. Parental involvement in the administration of buccal colostrum is recommended. Nursing staff may teach and supervise them to give colostrum.
  11. Administration of buccal colostrum must be recorded on BadgerNet

Provenance

Record: 2807
Objective:
Clinical condition:

Vulnerable neonates requiring admission to Neonatal Unit Services

Target patient group: All relevant neonates receiving care within the neonatal service, where maternal factors are such that breast feeding/breastmilk feeding are not contraindicated. E.g HIV, contraindicated medication. All staff directly caring for babies within the neonatal service
Target professional group(s): Secondary Care Nurses
Midwives
Secondary Care Doctors
Adapted from:

Evidence base

  • Administration of oropharyngeal colostrum to infants in the neonatal intensive care unit guideline. Amna Nasuf (Child Health Academic), Dr Shalini Ojha ( Neonatal Consultant) Chris Jarvis (Clinical Paediatric Dietician) Dr Jon Dorling (Neonatal Lead Consultant). Nottingham Children’s Hospital. https://www.nuh.nhs.uk/handlers/downloads.ashx?id=6907
  • British Association of Perinatal Medicine (2020) Maternal Breast Milk toolkit. Optimising Maternal Breast Milk for Pre-term Infants: A Quality Improvement Toolkit
  • BREASTFEEDING, S. O. 2012. Breastfeeding and the Use of Human Milk. Pediatrics, 129, e827- e841.
  • DIANE L. SPATZ, P. R. F., AND TARYN M. EDWARDS, BSN RNC 2009. The Use of Colostrum and Human Milk for Oral Care in the Neonatal Intensive Care Unit. National Association of Neonatal Nurses E-News.
  • Guideline: Buccal Colostrum for Infants Admitted to the Neonatal Unit. Jessop Wing Neonatology (E. Pilling, Neonatologist et al) 2020.
  • Guideline: Early administration of Buccal Colostrum to sick and premature infants admitted to the NNU. SWMN ODN (Sara Clarke, Senior Specialist Neonatal Dietitian). http://www.swmmnn.org.uk/wp-content/uploads/2017/11/guideline-forbuccal-colostrum-finalsept2017-EF.pdf
  • Nasuf, A, Ojha, S., Dorling, J. (2015). Oropharyngeal colostrum in preventing mortality and morbidity in preterm infants (Protocol). Cochrane database of systematic reviews. http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD011921/pdf
  • RODRIGUEZ, N. A., MEIER, P. P., GROER, M. W. & ZELLER, J. M. 2009. Oropharyngeal administration of colostrum to extremely low birth weight infants: theoretical perspectives. Journal of Perinatology, 29, 1-7.
  • RODRIGUEZ, N. A., MEIER, P. P., GROER, M. W., ZELLER, J. M., ENGSTROM, J. L. & FOGG, L. 2010. A pilot study to determine the safety and feasibility of oropharyngeal administration of own mother's colostrum to extremely low-birthweight infants. Adv Neonatal Care, 10, 206-12.
  • SEIGEL, J. K., SMITH, P. B., ASHLEY, P. L., COTTEN, C. M., HERBERT, C. C., KING, B. A., MAYNOR, A. R., NEILL, S., WYNN, J. & BIDEGAIN, M. 2013. Early administration of oropharyngeal colostrum to extremely low birth weight infants. Breastfeeding Medicine: The Official Journal of the Academy of Breastfeeding Medicine, 8, 491-5.
  • Snyder, R., Herdt, A., Mejias-Cepeda., Ladino, J., Crowley, K., Levy, P. 2016. Early provision of orophayngeal colostrum leads to sustained breast feedings in preterm infants. Pediatrics and Neonatology, http://dx.doi.org/10.1016/j.pedneo.2017.04.003 10

Approved By

Trust Clinical Guidelines Group

Document history

LHP version 4.0

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