Oral therapy with own mother’s milk (OMM) – Transition to at-breast feeding interventions

What is oral therapy with OMM?

Oral therapy (also known as oropharyngeal care) is the regular application of small amounts (0.1 – 0.2 ml) of own mother's milk (OMM) inside the infant’s cheeks until oral feeds begin.^1-6

This can be performed from birth:

•  As regular mouth care for the smallest and sickest extremely low birth weight (ELBW) infants (including those nil per os).^2,4
•  Every 2–6 hours with enteral feeds.^4,5
• As oral stimulation for non-nutritive sucking (NNS).²

Evidence consistently demonstrates oral therapy is safe, inexpensive, feasible and well-tolerated, even in ELBW infants (weighing less than 1000g).^1,2,4

Why is oral therapy with OMM important?

Colostrum and early OMM are high in immunologic, anti-infective and anti-inflammatory factors.^2,7 Oral therapy to date is positively associated with

• Reduced risk of clinical sepsis⁴
• Inhibition of secretion of pro-inflammatory cytokines⁴
• Increase in levels of circulating immune-protective factors in ELBW infants⁴
• Support of the reduction in days of total parental nutrition⁸
• Support of earlier commencement of enteral and oral feeds^9,10

Oral therapy is considered a form of immune therapy.^2,4-6

Use of OMM via oral therapy has been shown to:

• Focus on critical hours after birth

• Obtain colostrum for therapeutic oral application
• Motivate and sustain the mother to initiate early, frequent pumping and to continue expressing milk.^5,6
• Provide parents an opportunity for meaningful participation in their infant’s care, enhancing bonding and promoting maternal confidence.⁶

How to implement oral therapy with OMM

• Support the mother to initiate expressing early (within 3h of birth) and frequently ( 8 or more times/ 24h) for own mother’s colostrum.
• Commence oral therapy with OMM/colostrum within 24 hours of birth¹
• Administer oral therapy every 2-6 hours until oral feeds commence
• Advocate freshly expressed OMM/colostrum for oral therapy (within 1h of expression)⁶
• Teach and support parents to deliver oral therapy to their own infant
• Document administration of oral therapy, as well as any reason for omitting the therapy

How to monitor oral therapy with OMM

Collect data on daily administration and frequency of oral therapy

Carry out a monthly data review to measure and monitor first use and frequency of oral therapy:

• % percentage of eligible infants that receive oral therapy

a) within 24 hours after birth

b) every 2–6 hours until oral feeds commence

• reasons for sub-optimal provision of oral therapy

Evaluating infant records on a monthly basis within a quality improvement framework, highlights progress, identifies challenges and supports interventions to improve lactation outcomes.