Feeding sick newborns in a developing world hospital nursery: Dutch neonatologist GF Drejer and perinatal nurse/midwife Lennie Kamwendo describe experiences in Malawi and draw conclusions from their practice.

• Auteur: Drejer, G.F.

This article describes some of the problems of feeding newborns admitted to the newborn nursery of a large maternity department in a developing country (Table 1), where babies are dependent on breastfeeding as their sole source of food. This dependency remains even when their mother are sick and unable to provide enough milk. When (sick) babies are not fed sufficiently and frequently, exhaustion and hypoglycaemia in the hours after birth, and starvation within days, may overshadow the problem for which they were originally admitted.

In our opinion, hypoglycaemia, exhaustion and starvation should not need to be treated in the first place, but prevented by timely feeding.

In any paediatric department in the developing world, children are admitted together with their mothers. However, this is seldom the case where newborns are concerned and the separation may seriously hamper the initiation and maintenance of breastfeeding. It should be mandatory to keep mother and baby together from birth on, as survival of the babies is totally dependent on their mothers' milk. Yet it is understandable why mothers and sick babies are admitted separately. Most newborns are admitted from the labour ward or operating theatre, because of acute problems occurring immediately after birth. It is often difficult to assess how serious their condition really is, at that moment. Temporary symptoms, due to adaptation to extra-uterine life, and real pathology are often indistinguishable and overlapping. To admit the mother together with, or shortly after, her baby to the same ward involves insuperable problems of logistics, staff and space.

Unavoidable as it may be, the separation of mother and baby does not help the problem of how and what to feed the baby. Each baby should receive a first feed within a maximum of three hours after birth and should continue to feed, preferably on demand or with intervals of no more than three hours.

It is, moreover, obvious that many newborns are too sick to be breastfed, or to take adequate expressed breast-milk (EBM) by cup or spoon. Mothers may be unable to come to the nursery for a number of reasons: for example, they may have had a Caesarean section, be suffering from pregnancy-induced hypertension or have developed puerperal sepsis. In these instances, where the mother cannot feed her baby, care must be provided exclusively by the midwife, assistant nurses or, in some cases, relatives of the mother. EBM is rarely sufficient...