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College of Human and Health Sciences, Swansea University

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A study on domperidone, a medication that increases milk supply in mothers of premature babies.

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What did it find?

Domperidone increased mean daily expressed milk volume by 88ml/day (95% confidence interval [CI] 57 to 112; five studies, 192 women). The amount was similar after five or 14 days of treatment and considered clinically important in this situation.

Separate analyses by study quality showed differences in the results. In studies rated as low risk of bias, milk production increased by 122ml/day (95% CI 75 to 169; two studies, 75 women). In studies rated as high risk of bias, milk production increased by 61ml/day (95% CI 19 to 104; three studies, 117 women).

Domperidone did not increase the risk of adverse events in mothers (risk ratio 1.05, 95% CI 0.65 to 1.71; five studies, 192 women). Adverse events included a headache, gastrointestinal, respiratory, and neurological symptoms such as sleep disturbance and dizziness.

No women withdrew from the studies because of adverse events, and no serious adverse events were reported. Only one study specifically measured effects on the mothers' heartbeat, in which no effects were seen.

Two studies reported no adverse events in infants in either group. Neonatal adverse events were seen in 14 infants in both groups in one study. This study measured effects on the infants' heartbeat (long QTc syndrome). Long QTc syndrome was seen in two babies at the start of the study and in three babies at the end of the study. They did not require any treatment. It was not clear whether the mothers of those babies had taken domperidone or placebo.

What are the implications?

Domperidone can increase breast milk supply in mothers with premature infants who need to be fed with expressed breast milk. The risk of irregular heartbeats may be lower with short-term use in new mothers than was seen with regular use in people older than 60 years. The number of women studied is too low to be sure of its safety.

Domperidone does not have marketing authorisation in the UK for increasing breast milk supply. Informed consent should be obtained and documented before use, following the General Medical Council's prescribing unlicensed medicines guidance.

What did it find?

Domperidone increased mean daily expressed milk volume by 88ml/day (95% confidence interval [CI] 57 to 112; five studies, 192 women). The amount was similar after five or 14 days of treatment and considered clinically important in this situation.

Separate analyses by study quality showed differences in the results. In studies rated as low risk of bias, milk production increased by 122ml/day (95% CI 75 to 169; two studies, 75 women). In studies rated as high risk of bias, milk production increased by 61ml/day (95% CI 19 to 104; three studies, 117 women).

Domperidone did not increase the risk of adverse events in mothers (risk ratio 1.05, 95% CI 0.65 to 1.71; five studies, 192 women). Adverse events included a headache, gastrointestinal, respiratory, and neurological symptoms such as sleep disturbance and dizziness.

No women withdrew from the studies because of adverse events, and no serious adverse events were reported. Only one study specifically measured effects on the mothers' heartbeat, in which no effects were seen.

Two studies reported no adverse events in infants in either group. Neonatal adverse events were seen in 14 infants in both groups in one study. This study measured effects on the infants' heartbeat (long QTc syndrome). Long QTc syndrome was seen in two babies at the start of the study and in three babies at the end of the study. They did not require any treatment. It was not clear whether the mothers of those babies had taken domperidone or placebo.

What are the implications?

Domperidone can increase breast milk supply in mothers with premature infants who need to be fed with expressed breast milk. The risk of irregular heartbeats may be lower with short-term use in new mothers than was seen with regular use in people older than 60 years. The number of women studied is too low to be sure of its safety.

Domperidone does not have marketing authorisation in the UK for increasing breast milk supply. Informed consent should be obtained and documented before use, following the General Medical Council's prescribing unlicensed medicines guidance.

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Domperidone increases breast milk in mothers of premature babies

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What did it find? Domperidone increased mean daily expressed milk volume by 88ml/day (95% confidence interval [CI] 57 to 112; five studies, 192 women). The amount was similar after five or 14 days of treatment and considered clinically important in this situation. Separate analyses by study quality showed differences in the results.

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Tommy's - The Neonatal Intensive Care Unit (NICU)

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Tommy's - The Neonatal Intensive Care Unit (NICU)

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Premature (or preterm) birth is when a baby is born before 37 weeks of pregnancy. If this happens, your baby may need special care and treatment.

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Small Wonders Videos from Best Beginnings

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Small Wonders Videos from Best Beginnings

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Small Wonders has been designed to help you on your journey with your sick or premature baby.

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This information is available in verified by experts in our Editorial Board including representatives from Royal College of Midwives, Royal College of Paediatrics and Child Health and Royal College of Psychiatrists as well as other key health organisations in the UK. To download Baby Buddy, visit the relevant app store of your choice:

Introduction

The first video from the Small Wonders DVD explains the different levels of care your baby might need, and who might give it. We meet some of the families and hospital staff, and guide you as to how to use this DVD to get support, wherever you are on your journey.

In the second video from the Small Wonders DVD, we meet three families, two who had time to prepare for life in a neonatal unit and one who had very little warning. We see three births, one of which is the birth of triplets, and we follow the babies being prepared for transfer to the neonatal unit.

First hours

The third video from the Small Wonders DVD provides a look into the first hours and days in the neonatal unit and shows you how you, as a parent, can play a very important role in your baby's care.

Expressing breast milk

The fourth video from the Small Wonders DVD shows how mothers can express breast milk for their baby within a few hours of giving birth (if at all possible mothers should express milk within the first 6 hours after giving birth). Starting to express breast milk early and expressing milk often will help your body produce plenty of milk for the weeks and months to come.

Holding your baby

The fifth video from the Small Wonders DVD shows how skin-to-skin contact (also known as 'kangaroo care') can help both you and your baby. You will see families move from being nervous to being able to hold their babies with confidence.

Your time in hospital

The sixth video from the Small Wonders DVD follows families as they begin to feel more confident in caring for their babies on the neonatal unit. You will also see how some of our families cope with their baby's condition getting worse.

Feeding independently

The seventh video from the Small Wonders DVD follows four families as they learn to help their babies feed independently of tubes. Although some babies may go home being fed by tube, most will be feeding independently before they are discharged from hospital, whether they are breastfeeding or formula-feeding.

Preparing for home

The eighth video from the Small Wonders DVD covers what to expect when your baby is ready to leave hospital. We follow five families as they prepare to go home.

First months at home

The ninth video from the Small Wonders DVD follows nine families enjoying the early weeks and months at home with their pre-term baby. They all have different experiences and challenges.

Twins and triplets

The tenth video from the Small Wonders DVD follows four families who had twins or triplets and discovers some some of the joys and challenges that come with having more than one baby.

Bereavement

This video from the Small Wonders DVD is only for families who have to deal with bereavement. We have included it because parents asked us to. Only watch this video if you feel it will be helpful to you and please be aware that everyone's experience of bereavement is different and may not reflect your own. This film follows the journeys of families who lost babies during filming and chose to carry on sharing their experiences to help others.

The twelfth and final video from the Small Wonders DVD shows the families whose journeys we have been following in films 1 to 10 looking back on their experiences and sharing their thoughts and feelings.

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The Impact Lead will focus on developing Best Beginnings' frameworks for monitoring and evaluating our national and international work ensuring that learning continues to be captured in ways that can be shared and used for effective advocacy and influencing. The successful candidate will also play a pivotal role influencing policy and its implementation within the maternity, early years, digital health and public health context.

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The Small Wonders videos have been designed to help you on your journey with your sick or premature baby.

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Bob, whose experience of fatherhood was unlike anything he had expected.

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A cartoonist's journey into first-time fatherhood

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Telegraph cartoonist Bob returns with an animated tale of his family's first holiday abroad. Father's Day at Sea follows on from the critically acclaimed illustrated memoir, Father's Days, charting his experience as a first time father learning to cope when his daughter suffers a brain injury during labour.

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Ever since our daughter, Poppy, was born three and a half years ago with brain damage, my wife and I have tried to avoid scenarios that could potentially end in disaster. Poppy is happy, she's cheeky, she's determined. She also has cerebral palsy and epilepsy.

When your child is diagnosed with a disability, the world suddenly seems like a scarier place, full of alarming hazards and impossible challenges. But we have tried as much as possible to give her a normal life. Her brother Dillon was born 20 months later - thankfully, without complications.

Since then, the four of us had settled for the security of not venturing too far from home, except to attend Poppy's frequent hospital appointments. My wife Sal and I like to think that we cope with most of the challenges life has thrown at us, but we'd be lying if we said what we've been through hasn't changed us. Where once we loved to travel, since having our children, we had convinced ourselves that we just wouldn't be able to cope with anything more ambitious than a quick trip down the motorway to stay with the grandparents.

That changed last year, when a colleague suggested that a cruise - where the hotel moves with you - might be particularly well-suited to a child with special needs. Poppy has always loved to swim because being in the water relaxes her over-tensed muscles. Larger ships come with several pools. At three, she could walk independently, but fell over frequently and couldn't always see steps or holes because of her poor eyesight. There would be lifts (26, in fact) between decks, I reminded myself, and long, flat stretches of deck space. There would be plenty of crew around to lend a hand.

Still, Poppy has epilepsy and her fits can be severe. What if she had one on the ship? She can't walk for long periods. With Dillon still so little, we go everywhere with our double buggy. It's enormous. Sal and I were both plagued by (admittedly ridiculous) visions of Poppy falling overboard in the lead up to our departure. But our greatest fear was: "What if we spend the rest of our lives as parents never venturing away from our safe little Hampshire terrace?"

We decided to give it a try and booked a week-long cruise around the Med.

On the morning of the trip I woke in a state of panic, convinced that we would forget some crucial item of luggage. As we made our way through the busy airport for our flight to Genoa, I started to wonder if we were making a huge mistake.

We had done some research and plumped for MSC Cruises, whose ships and facilities promised a relaxed and fun experience for families without compromising on the more luxurious elements of a grown-up cruise. The route we chose began and ended in Genoa, in north-western Italy, and included stops at Sicily, Spain, Malta and France.

It's hard not to be awestruck when confronted for the first time, by 139,000 tons of cruise ship. When we travelled, our ship, Preziosa, was the newest vessel in the fleet. Costing US$550 million, she is 1,092 feet long and 17 decks high. Plenty of room, then, for us and the ridiculous amount of luggage we'd brought.

While the size of the ship was overwhelming, the size of our cabin was disappointingly small (on reflection we should have booked one of the 45 designed for those with accessibility issues) - which was an added challenge for Poppy, who finds it difficult to move around without a lot of space. And she wasn't the only one who struggled with the cramped conditions - changing a nappy in a small cabin will likely end in disaster.

Sal and I began to feel a bit trapped by life at sea. Dillon was too young for the kids' club and Poppy's complex needs, limited mobility and lack of Italian (this was the main language spoken by our fellow passengers) made it impossible for us to leave her there alone. I hoped that things would improve on the excursions ashore.

In Malta, we booked a trip to the beach. Poppy and I went swimming in the sea while Sal relaxed in the sun and Dillon stood, transfixed, staring up at the lifeguard in his tower for 20 minutes. Then everybody buried me in the sand. It was bliss.

But the rest of the excursions involved two hours on a coach for a one-hour visit; it just wasn't practical with small children and all of their clobber.

The ship's Continental approach to mealtimes and bedtimes was difficult to accommodate. Sal and I began to wonder what had we done?

Then, one morning, everything started to change.

An exercise class on the main deck caught Poppy's attention. Before I knew it, she disappeared into a crowd of passengers. I panicked.

A moment later, she appeared on the stage next to the instructor. Borrowing the headset, Poppy introduced herself to the crowd of elderly Italian ladies and proceeded to perform some moves of her own, which the signoras dutifully mimicked. Poppy was in her element. No one watching could see a disabled child; they saw my cheeky, confident, life-loving daughter.

Watching her, it dawned on me how much my children were getting out of all of this. While Sal and I had been looking at meals as obstacle courses to get through, Poppy and Dillon revelled in the late dinner time. Poppy sat up beautifully and blushed when the waiter ceremoniously placed a cloth napkin on her lap. Dillon smashed only one tumbler.

While the grown-ups were busy moaning about the unfamiliar, Poppy and Dillon were embracing all of the new experiences: the different food; foreign cultures; the bizarre floating all-singing, all-dancing European carnival at sea that was our cruise ship.

One afternoon Poppy and I plonked ourselves at the front row of a children's theatre show for children.

I was unsure how much Poppy would be able to see with her impaired vision. I settled in somewhat reluctantly for a kitsch medley of Disney songs performed by the ship's actors in full costume. Our total commitment to CBeebies' Mr Tumble meant the kids had had limited exposure to Disney films. But Poppy, who sat staring with an open mouth, was captivated. Then she started grabbing my arm and pointing out things on stage. She giggled as the lights caught the tips of her shoes and observed that the Beast, who was pining after Beauty, looked a lot like her uncle Patrick. At the end, she got out of her seat and applauded so enthusiastically that her glasses fell off.

There are times as a Dad when I feel like I know exactly what I'm doing. And there are times when I feel less in control - and that's exactly as it should be.

Returning to Genoa to disembark, it felt like we'd been cruising a lot longer than a week. After all, we had visited four different countries and learnt how to buy a buggy inner-tube in Italian and Spanish. But by the time we disembarked, it didn't feel like the ordeal we thought is would be on day one. Rather, we had conquered our fears and risen to the challenge as a family.

As we ate dinner at a clifftop restaurant in Genoa, our cruise ship sailed into view on its next circuit of the Med. We reflected on what it had given us: new experiences; funny stories; happy memories; and, best of all, confidence.

We waved goodbye, happy in the knowledge that we were now a fully travel-compatible family unit. Then Dillon sent another tumbler flying through the air.

A four-berth cabin on a seven-night Mediterranean cruise on board MSC Meraviglia departing from Genoa and calling at Naples, Messina, Valletta, Barcelona and Marseilles costs from £2,936 for a family of four. Excludes flights but includes an all-inclusive drinks package (020 3856 3087; msccruises.com).

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Ever since our daughter, Poppy, was born three and a half years ago with brain damage, my wife and I have tried to avoid scenarios that could potentially end in disaster. Poppy is happy, she's cheeky, she's determined. She also has cerebral palsy and epilepsy.

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A highly unpolished artwork and personal story of boobs and babies.

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A highly unpolished artwork and personal story about boobs and babies.

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You and your baby. Supporting love and nurture on the neonatal unit.

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Premature birth - information and support:

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What is premature birth?

The definition of a 'premature' or 'preterm' baby is one that is born before 37 weeks. There are different categories levels of prematurity and these carry their own risks:

Extremely preterm (less than 28 weeks)

very preterm (28 to 32 weeks)

moderate to late preterm (32 to 37 weeks).

What are the symptoms of premature birth?

The following symptoms before 37 weeks of pregnancy could be signs that you are about to go into labour:

an increase in pelvic pressure within the vagina or rectum.

an increase in discharge and/or a gush/repeat trickling of fluid, which could mean your waters have broken (preterm premature rupture of membranes).

bleeding or losing your mucus plug.

period type pains in your abdomen or lower back. These may have a rhythm or be constant.

If you have these symptoms contact your hospital.
Read more about the signs of premature labour here. Read more about being told you are at risk of premature birth here.
What is the treatment for premature birth?

If a pregnancy is found to be at high risk of premature birth, the mother is treated to extend the pregnancy as far as possible. There are various ways this is done.

Read about treatment for a pregnancy that is at high risk of premature birth here.
Read about treating your premature baby in hospital after they are born here.
How common is premature birth?

In the UK, around 60,000 babies are born prematurely each year. The rate of preterm birth is between 7-8% across the UK.

Read more premature birth statistics.

To talk to other parents of premature babies, visit BabyCentre's friendly prematurity support group.

What are the causes of premature birth?

In some cases a cause of preterm birth can be shown but more often it is unknown or unclear. Complications, such as infection or cervical incompetence increase the risk. Women who are having a multiple pregnancy (twins, triplets or more) are also have a higher chance of giving birth prematurely. The average length of pregnancy for twins is 37 weeks, and 33 weeks for triplets.

In 25% of preterm births, the delivery is planned because the mother and/or baby are suffering life-threatening complications such as pre-eclampsia, kidney disease or growth restriction.
Read more about the causes of premature birth.
Why is premature birth a problem?

During the nine months of pregnancy babies' bodies are developing in the womb to allow them to survive and thrive when they are born. When a baby is born too soon, some parts of their development will not have been finished and this means they are not ready for life outside the womb.

Luckily advances in neonatal care have come on greatly and neonatal units, special care units and paediatricians are equipped to support the baby until their bodies strengthen and develop fully.

However, the earlier a baby is born the higher the risk is of health problems. There are different levels of prematurity, and generally the risk increases the earlier the birth is - babies at highest risk are those born before week 26.
Read more about the effects of premature birth.

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Tommy's - Premature birth - information and support

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The definition of a 'premature' or 'preterm' baby is one that is born before 37 weeks. There are different categories levels of prematurity and these carry their own risks: Extremely preterm (less than 28 weeks) very preterm (28 to 32 weeks) moderate to late preterm (32 to 37 weeks).

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Small Wonders are 12 bite-size films following families and their journey in neo-natal units.

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More than 1 in every 10 UK babies is born prematurely or sick. As well as professional support there's so much that only you as a parent can do to make a real difference to your baby's chances of growing up fit and strong.

It can be very distressing to be told when you're pregnant that your baby is likely to be born prematurely, however there are so many ways you can make a real difference to their health and wellbeing.

Small Wonders are 12 bite-size films following families and their journey in neo-natal units.
Topics covered:

Birth

First hours

Expressing breast milk

Holding your baby

Your time in hospital

Feeding independently

Preparing for home

First months at home

Twins and triplets

Bereavement

What is Small Wonders?
Seeing how other parents have coped in a similar situation can be comforting. Seeing them become involved in their baby's care can help you feel more confident to get involved in your own baby's care.

The films, endorsed by seven Royal Colleges and many charities, aim to support families of sick and premature babies through their experiences and form the heart of a National Change Programme.

Best Beginnings has supplied Small Wonders DVDs to around 150 neonatal units in hospitals across the UK. The films address sensitive situations, some of which may not be right for you at this time. If in doubt, ask the advice of your hospital staff before watching.

We have worked closely with over 200 families, experts and endorsing organisations to produce these films and the DVD has been endorsed by over 20 organisations, including UNICEF and RCPCH.
How do I watch Small Wonders?
For a quick look at the Small Wonders, click . You can also watch online on the Baby Buddy app , on our YouTube channel, and on the desktop version of Baby Buddy. You can buy copies of the Small Wonders DVD, which comes with the supporting booklet, from our online shop. If you are a parent of a sick or premature baby you can receive a copy of the DVD for free through your hospital.
Ways parents can participate in their baby's care:

Regular skin-to-skin/kangaroo care. Skin-to-skin contact reduces susceptibility to infection and can help to stabilise a baby's temperature and reduce the length of hospital stay. It also improves awareness and helps mother to produce milk

Providing and feeding breast milk to your baby, for example through expressing. Breast milk is very important because it reduces infections and advances mental and emotional development

Providing comforting touch and comfort holding. Time spent holding or touching your sick or premature baby allows you to bond, which increases your baby's responsiveness and lets you get to know one another

Day-to-day care such as nappy changing or bathing your baby

Best Beginnings collaborates with other organisations to ensure that families receive the best possible support. For more information regarding premature and sick babies, visit the Bliss website or call their Family Support Helpline for free on 0500 618140.
What mums and dads think of Small Wonders
"I found the films useful as I am in a similar situation as some of the parents and it gives a good idea of what to expect."

"I have had a premature baby but I learnt a lot from watching these films. There are a MUST for parents who haven't had previous experience of a neonatal unit. Really good!"

"Absolutely fantastic films. Very informative and a great insight into what's to come when having a premature baby. So glad that I got a chance to watch these as it really helped myself and my partner."
Want to know more about Small Wonders?
Visit the Small Wonders Impact and Evaluation page.
To find out how Best Beginnings can work with you in your are and use our Small Wonders resources email Carly, our Head of Operations at [email protected]

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It's #VolunteersWeek and Harry, Beatrice and Francesco, our dear volunteers and interns, share their experience of volunteering for Best Beginnings. Read more

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More than 1 in every 10 UK babies is born prematurely or sick. As well as professional support there's so much that only you as a parent can do to make a real difference to your baby's chances of growing up fit and strong.

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Sally Tracy, Professor of Midwifery, talks about her research into neonatal care after induction or cesarean. 

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Sally Tracy, Professor of Midwifery, talks about her research into neonatal care after induction or cesarean. 

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One World Birth is a new FREE online video resource with the aim of sharing evidence-based information from the world's leading birth experts

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Prof. Sally Tracy on neonatal care after induction or cesarean

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their telephone line is closing:

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Why are we changing the helpline?

We recently conducted research which told us that we need to make changes to the way we offer support to the parents of premature and sick babies in order to reach them at their time of need.

Whilst we're very proud of what we currently offer, we know there are groups of parents we're just not reaching with our services. As the internet and social media develop even further, parents are looking to engage with support services in a number of different ways, and we need to evolve to meet their changing needs in order to have the biggest positive impact for babies.

During a review of the telephone helpline we also found that calls have reduced by 80% since April 2016.

Why are there fewer calls to the helpline?

Helpline services across the UK have experienced a decline in recent years. Increasingly, people opt for other methods of communication and charities are providing services through a mix of channels, including text-in services, webchat, message boards, Facebook groups and Twitter conversations.

While calls to our helpline have declined, the Bliss and Netmums Forum continues to be a valuable peer support service for parents. Visits to the 'parent' section of our website have increased by approximately 10% in the last six months alone, suggesting more parents are finding the information and support they need online. We also have Bliss Champions supporting parents on units across the country and we're continuing to evolve our information in response to parents' needs, such as the new podcast we created to support parents' mental health on the unit.

What might a new service look like? And when will it be available?

Over the coming months, with the help of parents and volunteers, we will be researching the best methods of supporting parents with a baby in neonatal care.

We do not yet know exactly what a new service will look like as we still have some work to do to understand what families need most. But, based on current trends, it is likely to involve a mix of online and offline services. We will look to build on what has been successful at Bliss and try new approaches to reach parents when and where they need us.

We will take our time to make sure we get it right and use our money wisely, but we're also keen to provide a new service as soon as is feasibly possible.

How can parents access support going forward?

Families looking for information and support can still contact the helpline via hello@bliss.org.uk and they can find a wealth of information and support on our ' Parent' pages and in print from our shop. Many parents can access support via a Bliss Champion on their neonatal unit. Others can find a supportive community of parents on Bliss' Facebook page and the Bliss and Netmums Forum.

Thank you to our helpline volunteers

Each one of our helpline volunteers have made a lasting, and often life-changing, contribution to the lives of families caring for premature and sick babies. We would like to extend our heartfelt thanks to everyone who has contributed their time, energy, understanding and compassion to supporting babies as part of the Bliss family.

We hope the volunteers who helped to make the helpline such a fantastic service over the years can continue to use their skills and passion to support babies through our other areas of our work.

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Bliss to change services to better meet parents' needs | Bliss

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Bliss will be closing the telephone part of the helpline at the end of January 2019 whilst we work with parents to evolve the service into something that better meets their needs. Families will still be able to contact Bliss for support at hello@bliss.org.uk

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For babies born premature or sick | Bliss

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Our vision is that every baby born premature or sick in the UK has the best chance of survival and quality of life.

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My premature baby app:

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Tommy's has launched a new free app for parents of premature babies. It is the first of its kind in the UK.

My premature baby is available on all devices (phones, tablets and desktop computers.)
Download it for Apple devices here Download it for Android devices here
The app contains all the prematurity information from the Tommy's book: Having a premature baby. This book was published in 2011 and has received a Highly Commended Award in the British Medical Association Patient Information Awards (2014).

In addition to providing all our information in an easily-searchable format, the app also has the following features:

a development diary - allowing parents to record events, thoughts and milestones

a feeding log - allowing parents to record times, type and amount of food given

ability to easily share information with family and friends on Facebook

ability to track the baby's weight on a growth chart

ability to find other parents going though similar experiences on a map.

The app functions on all devices: phones, tablets and desktop computers.
Get the app for Apple devices Get the app for Android devices

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Tommy's - Free app for parents of premature babies

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Tommy's has launched a new free app for parents of premature babies. It is the first of its kind in the UK. My premature baby is available on all devices (phones, tablets and desktop computers.) Download it for Apple devices here Download it for Android devices here The app contains all the prematurity information from the Tommy's book: Having a premature baby.