Successful lactation establishment in extreme prematurity despite multiple maternal risk factors: A - case report

Background Mother's own milk (MOM) is the optimal nutrition for preterm infants; however, establishing lactation is particularly challenging in mothers with multiple medical comorbidities and prolonged mother–infant separation. Case presentation We report the case of a 27-year-old mother who delivered dichorionic diamniotic twins at 25 weeks + 6 days of gestation. Twin 2 (730 g) received initial neonatal care at another hospital and was referred to our tertiary NICU on day 19 of life. The mother had hypothyroidism, polycystic ovarian disease, gestational diabetes mellitus, gestational hypertension, obesity, delayed initiation of milk expression, and prolonged mother–infant separation. At referral, milk production was <10 mL/day and the infant predominantly received donor human milk. A multidisciplinary lactation-support programme including intensive counselling, frequent milk expression, breast stimulation techniques, psychological support, non-nutritive sucking, oromotor stimulation, kangaroo mother care after clinical stabilization, yoga-based relaxation, and domperidone resulted in progressive improvement in milk production. Outcome At discharge after two months of NICU care, the infant achieved exclusive feeding with mother's own milk and satisfactory weight gain. Conclusion This case demonstrates that even after delayed referral and multiple maternal risk factors, intensive multidisciplinary lactation support can successfully establish exclusive mother's own milk feeding in an extremely preterm infant.