MOM NOSE Best: Mothers Own Milk Intranasally or Standard Care in Preterm Babies with Intraventricular Haemorrhage

Intranasal fresh mothers own milk (target 1.6ml/day in divided doses) for 28 days commenced as soon as possible after Germinal Matrix Haemorrhage-Intraventricular Haemorrhage (GMH-IVH) detection, in addition to standard care. 0.8ml of fresh mothers own milk will be administered twice per day clustered around routine infant nursing cares and timed with availability of fresh mothers own milk. During a care cluster 0.4ml fresh mothers own milk (0.2ml per nostril, delivered via droplets from a syringe) will be instilled immediately prior to and repeated immediately after a set of nursing cares . To ensure intranasal administration is tolerated, dosage will begin at 0.2mL (0.1mL per nostril) and increased over 24h. Nasal suction is to be avoided for an hour following mothers own milk intranasal administration. In case of nasal endotracheal tube placement, the full dose of mothers own milk will be administered into the contralateral nostril. All administration will occur within the neonatal unit by nursery staff. Doses will be prescribed and monitored using hospital electronic medical records. Breast milk collection: Lactation and expressing support and equipment will be offered to mothers as is standard care in the nurseries. Intranasal mothers own milk administration will need to occur within 3 hours of expression without prior refrigeration. To reduce the burden of this on families, fresh mothers own milk administration will be clustered so that only two fresh samples are needed per day (reduced to one cluster if necessary).