Title of Guideline (must include the word “Guideline” (not
protocol, policy, procedure etc)
Directorate & Speciality
Administration of Oropharyngeal
Colostrum to Infants in the Neonatal
Intensive Care Unit guideline (D3a)
Amna Nasuf (Child Health Academic) Dr
Shalini Ojha ( Neonatal Consultant) Chris
Jarvis (Clinical Paediatric Dietician) Dr Jon
Dorling (Neonatal Lead Consultant)
Family Health: Neonatal Unit
Date of submission
10.2.2017
Explicit definition of patient group to which it applies (e.g.
inclusion and exclusion criteria, diagnosis)
Patients of the Nottingham Neonatal Service
of the Nottingham University Hospitals NHS
Trust who fit the inclusion criteria of the
guideline.
Version
1
If this version supersedes another clinical guideline please
be explicit about which guideline it replaces including
version number.
Key Words
N/A
Author: Contact Name and Job Title
Oropharyngeal colostrum, Late onset sepsis,
Necrotising enterocolitis, Breast feeding
Statement of the evidence base of the guideline – has the guideline been peer reviewed by colleagues?
1
2a
NICE Guidance, Royal College Guideline, SIGN
(please state which source).
meta-analysis of randomised controlled trials
2b
at least one randomised controlled trial
3a
at least one well-designed controlled study without
randomisation
3b
at least one other type of well-designed quasiexperimental study
4
well –designed non-experimental descriptive
studies (ie comparative / correlation and case
studies)
5
expert committee reports or opinions and / or
clinical experiences of respected authorities
6
recommended best practise based on the clinical
experience of the guideline developer
Consultation Process
Ratified by:
Date:
Target audience
x
x
x
Nottingham Neonatal Service Staff and
Clinical Guideline Meeting, Midwifery
Services
Nottingham Neonatal Service Staff and
Neonatal Task & Finish Guideline group.
February 2017
Staff of the Nottingham Neonatal Service,
Delivery Suites and Postnatal Wards
Review Date: (to be applied by the Integrated Governance
March 2022
Team)
A review date of 5 years will be applied by the Trust.
Directorates can choose to apply a shorter review date,
however this must be managed through Directorate
Governance processes.
This guideline has been registered with the trust. However, clinical guidelines are guidelines only.
The interpretation and application of clinical guidelines will remain the responsibility of the
individual clinician. If in doubt contact a senior colleague or expert. Caution is advised when using
guidelines after the review date.
Document Control
Document Amendment Record
Version
Issue Date
Author
General Notes:
Summary of changes for new version:
2
Description
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Background
Colostrum is milk produced in the first few days after delivery. It is rich in immuno-protective and
growth factors such as immunoglobulin A, lactoferrin, and epidermal growth factor and has the
potential to modulate the infant’s 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.
Preterm infants are at a particularly high risk of late onset sepsis (LOS) and necrotising enterocolitis
(NEC) which can lead to death, increased morbidities, prolonged hospital stay, increased cost of
care, and worse long term outcomes among survivors. Some studies have demonstrated that giving
colostrum by the oropharyngeal route to preterm infants improves their immunity and may help to
reduce the risk of LOS and NEC.
Administration of oropharyngeal colostrum (OPC) is a new practice used to provide the benefits of
colostrum to infants and can be used even in the critically-ill, fragile preterm infants who cannot yet
tolerate enteral feeding. A small volume of colostrum is placed in the buccal cavity by a syringe or
swab. It does not require swallowing of colostrum by the infant but allows it to act locally and to be
absorbed by the buccal mucosa. Preliminary studies suggest that this is a safe practice, even in the
sickest preterm infants.
This guideline suggests a safe and practical procedure for administration of OPC to infants. It should
be used in conjunction with other infant feeding and oral care guidelines.
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Aim
To enable preterm and/or sick infants to receive mother’s own colostrum via oropharyngeal
administration.
Patient Group

Preterm infants (born <34 weeks gestation) admitted to the NICU
or

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4
4.1
Any infant who is not receiving feeds such as infants on respiratory support and/or inotropes
or with a surgical condition contraindicating feeding (e.g. gastroschisis, oesophageal atresia
+/- fistula, duodenal atresia).
Contraindications

Any contraindication for receiving mother’s own milk, such as maternal HIV infection

Breast feeding
Procedure
−
All mothers anticipating delivery of an eligible infant should be informed about the benefits of
colostrum and advised to express breast milk soon after delivery. This information must also
be included in antenatal counselling, wherever possible.
−
Administration of OPC should ideally be initiated within 6 hours of birth but otherwise as soon
as colostrum is available
−
Only the mother’s own colostrum should be used
−
Fresh colostrum should be used whenever possible but stored colostrum can be used (as
per the guidelines for breast milk storage)
Steps of administration
1. Provide mother with labelled sterile containers for colostrum collection. Labels should identify
mother’s name, infant’s hospital number, and the date and time of colostrum expression.
Colostrum can be collected in appropriately labelled 1 or 2 ml enteral syringes.
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2. When mother’s colostrum is available, separate two samples of 1.5 ml of fresh colostrum and
label them for use within the first 48 hours of birth/initiation of OPC.
3. Using clean gloves put 0.2 ml of mother’s colostrum in a 1ml enteral syringe, cap and label it.
At the infant’s bedside, verify that the medical records on the colostrum container match
those on the infant’s record chart.
4. Perform mouth care as routine.
5. 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 0.1 ml of
colostrum slowly. Place the syringe along the left side and another 0.1 ml of colostrum is
delivered by the same procedure.
6. Avoid oral suction for 30 min
7. Monitor the vital signs of the infant throughout the procedure.
8. Repeat the procedure every four hours for 3 days.
9. Record the procedure on the infant feeding record chart.
10. If feeds are commenced, the oral colostrum should be given first and then the NG feed. Oral
volumes should be recorded separately and not included as part of the feed volume.
11. Record any adverse effects on the chart and in the medical notes.
12. Parental involvement in the administration of OPC is recommended. Nursing staff may teach
and supervise them to give colostrum by this route.
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Information for parents
Parents should be given information about the benefits of mother’s colostrum/milk, preferably
antenatally, and the mother advised to start expressing milk as soon after delivery as possible.
Encourage mothers to express colostrum within 6 hours of delivery or as soon as possible and a
minimum of 4 hourly. Inform the parents that colostrum is initially expressed in small volume.
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For further information please contact:
[email protected]; [email protected];
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References
BREASTFEEDING, S. O. 2012. Breastfeeding and the Use of Human Milk. Pediatrics, 129, e827e841.
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.
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-birth-weight 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.
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