Milk Drop Care in the NICU: A Small Change with a Big Benefit

When a baby is born and needs to go to the NICU parents have many questions and they are in shock. One of the first questions parents ask is “When can I take my baby home?”  In my many years working and leading in the NICU, it does not matter how small or sick the baby is, parents are desperate to have something to hang on to that allows them to foresee a normal life in the future.

The average length of stay (LOS) is calculated in many ways, and the parents will be given an estimate. Some of the facts that influence the estimate are; the gestational age (how far along the pregnancy was) at birth, how well baby adjusts to breathing on their own, if they get an infection, how well they digest food, once it is given, and how well they gain weight. There is no one predicter that can tell a family how long it will be before they are all home together.

If there were a way to decrease the amount of time a parent had to be separated from their baby, wouldn’t that be something to celebrate and encourage? Well, the great news is, there is a new way to help get a baby home faster, and it has been proven to help.

 Medical Reasons the Length of Time in the NICU Matters

The length of time a baby spends in the NICU can increase the risk of complications and affect family bonding. But what if there were a credible way to decrease the LOS without adding cost or painful procedures? If that is possible, then time and effort need to be delegated to that new process. Well, good news, there is new research that has been done and has been shown to decrease the LOS.

How is a Small Baby Fed in the NICU

In the NICU, if a baby is very small, under 3 pound 5 ounces, they are called Very Low Birth Weight (VLBW). If you have had a VLBW baby in the NICU, you will know there is no bottle such a baby, in the first days or weeks of life would be able to use.  A VLBW baby is too small and does not have the developed reflexes that allow them to suck, swallow and breath in a coordinated way, allowing them to take food from a bottle or breast.

Yes, the baby must be fed. Early feedings are usually done through IVs. One special IV is called Total Parental Nutrition (TPN). TPN is used for people who have an inability to process food. It is also possible to give fat through an IV, usually called intralipids, which will help with growth and proper nutrition.

The VLBW will not have the physical ability to take the food nor are they able to digest the amount of food their body needs, but they will be nourished.  The IVs will make sure the baby gets nutrition. One thing that is missing is the normal developmental steps of eating which are motor skills that are required to successfully transition to oral feeding.

Is There Special Food a VLBW Needs?

When a baby is born prematurely, mom’s milk is different than if the baby had grown to full term inside mom. Mom’s body naturally adjusts to provide for the special needs of her small baby. It has been shown that a mom who delivers early, has milk with an increase in the amount of protein, minerals, and fat. This provides for the extra needs of the premature baby. Further, the nutrition and benefits of mom’s own milk has been shown to decrease inflammation and help stimulate the immune system in the throat area.  So, though the VLBW baby cannot take the milk from a bottle, there are important reasons this baby would benefit from receiving mom’s milk in their mouth.

Considering these facts led to an exploration of how mom’s milk can be introduced to baby, in the early days and weeks of life. In the last 15 years, it has become common to use mom’s expressed colostrum or breast milk (EBM) with newly born babies for oral care in the NICU. Colostrum is the first milk that is pumped after birth and is especially rich in nutrients, antioxidants, and antibodies

An noted advantage of oral care with EBM is the documented decrease in risk of ventilator associated pneumonia (VAP). Because many VLBW infants will spend time on a ventilator, they have a higher risk of acquiring VAP.

This type of oral care is done when the nurse dips a cotton swab in EBM, to massage the gums and the inside of the cheek every 3-6 hours.  The caregiver using EBM for oral care provides the baby with the benefit of a small amount of breast milk or colostrum which is absorbed through the cheeks and gums.  This has been a positive step forward and research has shown that there is a decrease in the occurrence of VAP, when oral care with EBM is used.

Milk Drop Care has taken this a step further. All the benefits received through oral care with EBM are now supplemented with the advancement of developmentally appropriate actions while giving the baby comfort, allowing them to accept or reject the care.

How is Milk Drop Care done?

·       Milk Drop Care begins in the first few days of the baby’s stay

o   There has been research on Milk Drop Care with babies as young as 25 weeks gestational age (15 weeks before the due date)

·       1-2 small drops of milk are offered every 2-4 hours

o   If the baby sucks, another drop will be offered

o   If the baby licks, another drop will be offered

o   If the baby refuses the drop, or is not interested, no further offering will be given until the next scheduled time

·       Mom’s own milk or colostrum is used

Benefits Seen by Parents and Baby

Once Milk Drop Care is introduced, the parents are shown how to offer the small amounts of breast milk to their babies. The positive feeling of being involved in caring for their baby is a move forward for the parents. Babies will be able to accept or reject any feeding, and their preference will be acknowledged. When they do accept the drops, the developmentally appropriate desire to suck will be encouraged. Each step a premature baby takes toward normal developmental activities is beneficial. The premature brain is maturing daily, and each movement forward helps the brain on that path.

What have the studies shown

There are many medical interventions used in the NICU to sustain neonates’ lives and decrease potential negative outcomes. Most of them are expensive and complicated. The typical parent of a NICU baby feels the sting of watching their infant receive care from others, delivered by machines, frequently not fully understanding what or why everything is being done.

With Milk Drop Care, the most basic human interaction from parent to infant is being promoted, feeding one’s baby. The process uses mom’s breast milk. The amount of breast milk is so small that a large majority of moms will be successful in providing all that is needed. Probably the best news for the parents, is that after being educated how to deliver the milk to their baby they can give the milk, without another person having to do it for them.  

A valuable addition to NICU Care

All the above are valid reasons to introduce Milk Drop Care in the NICU. However, perhaps the greatest benefit of all is the reduction in the LOS. Costs are reduced, the potential risk of complications that come with hospitalization are reduced, and best of all, on average, the family will go home together sooner. No one can determine exactly how much sooner, but some of the early results show up to an average of 11 days sooner.

As a new, valuable model of care, NICU’s across the nation are working to adapt this to their standard practice. Though it will take some time to make Milk Drop Care standard in any NICU, it comes with no increased cost, other than education, and the results for the baby, the family, and the medical team are positive.   

References

1)       Bertini, G., et al. (2024).The effect of oropharyngeal mother’s milk on nutritional outcomes in preterm infants: A randomized controlled trial. BMC Pediatrics, 24, Article 4621‑5. https://doi.org/10.1186/s12887-024-04621-5

2)       Cleveland Clinic. (2022, February 21). Colostrum: What it is, benefits & what to expect. Retrieved August 19, 2025, from https://my.clevelandclinic.org/health/body/22434-colostrum

3)       Kelich, F., Qalehsari, M. Q., Zabihi, A., Jafarian Amiri, S. R., & Danaee, N. (2024). The effect of oropharyngeal mother’s milk on nutritional outcomes in preterm infants: A randomized controlled trial. BMC Pediatrics, 24, Article 155. https://doi.org/10.1186/s12887-024-04621-5

4)       Milk Drop Central. (n.d.). Milk Drop Method. Retrieved August 19, 2025, from https://www.milkdropcentral.com/home-1

5)       Natarajan, G., Shankaran, S., & Pappas, A. (2021). Outcomes of extremely preterm infants with bronchopulmonary dysplasia in neonatal intensive care units. Pediatric Pulmonology, 56(4), 953–960. https://doi.org/10.1002/ppul.25142

6)       Parenteral Nutrition: What It Is, Uses & Types. (2022, April 19). Cleveland Clinic. Retrieved August 18, 2025, from Cleveland Clinic website: https://my.clevelandclinic.org/health/treatments/22802-parenteral-nutrition

7)       Rodríguez, N. A., Vento, M., Claud, E. C., Wang, C. E., & Caplan, M. S. (2023).Effect of oropharyngeal colostrum therapy on neonatal outcomes: A randomized controlled trial. Journal of Pediatric Gastroenterology and Nutrition, Advance online publication. https://doi.org/10.1002/jpn3.12085

8)       Stanford Medicine Children’s Health. (n.d.). The benefits of mother’s own milk. Retrieved August 19, 2025, from Stanford Medicine Children’s Health website: https://www.stanfordchildrens.org/en/topic/default?id=the-benefits-of-mothers-own-milk-90-P02339

9)       What Is Considered Low Birth Weight? (2025, August 5). Cleveland Clinic.

Retrieved August 19, 2025, from Cleveland Clinic website:

https://my.clevelandclinic.org/health/diseases/24980-low-birth-weight

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