When should colostrum be administered to newborns?

Colostrum Administration for Newborns

Colostrum should be administered to newborns within the first hour of birth through immediate skin-to-skin contact and early breastfeeding initiation. 1, 2

Timing of Colostrum Administration

• Immediate skin-to-skin contact between mother and infant should be established directly after birth to facilitate early breastfeeding and colostrum intake 3
• Breastfeeding should be initiated within the first hour of life, allowing the infant to root and latch on spontaneously 1, 2
• Common nursery routines such as weighing, vitamin K administration, and ocular antibiotic application can be safely delayed until after the initial breastfeeding session 2

Benefits of Early Colostrum Administration

• Colostrum contains essential antibodies that protect newborns against diseases 4
• Early breastfeeding prevents newborn deaths due to sepsis, pneumonia, diarrhea, and hypothermia 4
• Colostrum is the major source of secretory IgA, providing protection against gastrointestinal infections 5
• Colostrum establishes the infant's immune system and provides growth factors and other protective components 5

Protocol for Immediate Skin-to-Skin Contact and Colostrum Administration

1. After delivery and initial assessment of the newborn, dry and stimulate the infant for first breath/cry 3
2. If the newborn is stable, place skin-to-skin with mother with cord attached (option to delay cord clamping) 3
3. Continue drying the entire newborn except for hands to allow infant to suckle hands bathed in amniotic fluid, which facilitates rooting and first breastfeeding 3
4. Cover the infant's head (optional) and place prewarmed blankets to cover the body 3
5. Ensure safe positioning of the infant during skin-to-skin contact 3

Safe Positioning During Skin-to-Skin Contact

• Infant's face must be visible at all times 3
• Infant's head should be in "sniffing" position 3
• Infant's nose and mouth should not be covered 3
• Infant's head should be turned to one side 3
• Infant's neck should remain straight, not bent 3
• Infant's shoulders and chest should face the mother 3
• Infant's legs should be flexed 3
• Infant's back should be covered with blankets 3
• Mother-infant dyad must be monitored continuously by staff in the delivery environment 3

Special Considerations

• For HIV-positive mothers, breastfeeding should be avoided, and antiretroviral prophylaxis should be administered to the mother and newborn 3
• For mothers with unknown HIV status during labor, rapid HIV testing should be performed, and if positive, breastfeeding should be avoided pending confirmatory testing 3
• For very low birth weight infants, mother's expressed milk provides significant benefits including reduction of necrotizing enterocolitis, late-onset sepsis, and improved neurodevelopment 3
• Frequent feeding on demand, at least 8-10 times in 24 hours, decreases newborn weight loss and risk of clinically significant hyperbilirubinemia 3

Volume Expectations for Colostrum

• Within the first 3 hours postpartum, approximately 60% of mothers can express colostrum 6
• Initial colostrum volume is typically small: 0.4 mL (median) at 0-3 hours and 1.0 mL at 3-6 hours postpartum 6
• Colostrum volume may decrease after initial expression and remain low until approximately 30 hours postpartum before increasing dramatically (secretory activation) 6
• Multiparous women typically experience secretory activation earlier than primiparous women 6

Monitoring and Support

• Continuous monitoring by trained staff members during skin-to-skin contact is essential to prevent adverse events 3
• Frequent and repetitive assessments of newborn breathing, activity, color, tone, and position should be performed 3
• Healthcare providers should observe breastfeeding technique and provide guidance as needed 1
• Formula supplementation in the first 2 days should be avoided unless medically indicated 1

By following these guidelines for early colostrum administration, healthcare providers can help establish successful breastfeeding and provide optimal nutrition and immunological protection for newborns.