Patricia Kellicker, BSN
Premature babies, often called preemies, arrive earlier than the expected 38-42 weeks gestation. Because a premature baby’s organs are often not fully developed, they are at risk for health complications, such as breathing problems, infection, anemia, and low blood sugar. Depending on which complications arise, a premature baby’s nutrition may initially take a backseat to the larger issues. However, breast milk has been shown to play a crucial role in improving the health of premature infants.
Some premature babies won’t be able to breastfeed initially because they are not strong enough and their sucking-swallowing coordination is not yet developed. Also, because the gastrointestinal tract of many premature babies is often not yet fully developed, they must be fed very slowly and carefully, usually through a tube that is placed through the mouth or nose directly into the stomach. That doesn’t mean that these babies shouldn’t receive breast milk. In fact, breast milk contains many important antibodies that help fight disease and prevent infection, a benefit crucial to vulnerable preemies.
Another benefit of breast milk is that it plays an important role in preventing problems specific to preemies. An important area of study has been the protective effects of breast milk against necrotizing enterocolitis (NEC), a serious intestinal infection. One study showed that infants who received formula were more likely to develop NEC than infants fed breast milk. Some studies have suggested that premature infants fed their mother's breast milk were less likely to develop any kind of infection.
While mothers of premature babies naturally produce milk tailored to the needs of their small offspring, preemie breast milk may also be fortified with supplements called “human milk fortifiers” to provide additional needed calcium, vitamins, and protein. Clinical evidence has shown that preemies who received fortified breast milk experienced improved growth and a better nutritional status.
Since some preemies cannot suck effectively, mothers of these premature infants typically need to pump milk for their babies’ needs until the children are strong enough to breastfeed. Begin pumping as soon as possible, preferably within the first day. This is because colostrum, the earliest type of milk produced, is composed largely of antibodies and other proteins that serve to protect the baby and to help his or her stomach and intestines tolerate feedings.
Pumping breast milk also helps establish a milk supply. The more breast milk that is pumped, the more that is produced, so consistent pumping is key. Since mothers of premature babies are often under stress due to worries about their baby or a physical health condition that contributed to the premature birth, milk supply may fluctuate. But consistent pumping (every 2-2.5 hours during most of the day, with sleep or work breaks of no longer than 4-5 hours at a time) will lead to a well-established supply. Aim to pump at least 6-8 times each 24-hour period, for a minimum total pumping time of 100 minutes.
You may find that breast massage before and during pumping will increase milk flow and could even boost your milk production. Starting at the outer edges of your breasts, make small, circular motions with your fingertips, slowly moving inward toward your nipples. Massage gently so that you are not causing pain.
If you are having trouble producing enough milk for your baby, you may want to try hand expressing (rather than using a pump). Some mothers prefer this method when expressing colostrum. Get plenty of rest, stay hydrated, and try to minimize stress as much as possible.
When it comes time to transition your baby to feeding directly from the breast, there are several interventions that lead to improved breastfeeding success: organized maternal support and education, kangaroo care (placing the infant skin-to-skin against the parent’s chest), and nonnutritive sucking on the breast may help during the process. Try to time feedings when your baby is awake and alert, but calm. Try a variety of different positions until you find the one that works for you.
Once your baby is ready for breastfeeding you will notice signs. Rooting is one such sign: stroking the baby’s cheek results in turning the head in the direction of your hand with the mouth open, ready to suckle. Other signs of readiness include the ability to latch on and suck, increasingly alert wakefulness when feeding, and the overall comfort level during feeding. In the early weeks, you should nurse your baby every time he or she shows any interest.
Premature babies who are used to being fed through a tube may experience some difficulty when first learning to breastfeed. It may take some time to teach your baby how to latch on to the breast. Consult a lactation consultant right away if you are having any trouble. Placing some milk on your nipple or into the corner of your baby's mouth as he latches on may help. You may need someone to help you do this. If your baby has grown to prefer a bottle or tube feeding over breastfeeding, you may be able to use a special device that will deliver expressed breast milk through a tiny tube taped next to your nipple. This way, your baby will feed partly from the tube and partly from your breast until he or she can be transitioned to fully breastfeeding.
Your baby may become tired very easily or have trouble sucking hard enough to pull milk out of your breast. Gently massaging or compressing your breast can help to push the milk out of your breast to your baby. Be careful that you are not giving your baby too much milk too quickly, or they may become overwhelmed.
So, while no mother expects to deliver prematurely, it is never too early to plan how your baby is to be fed. For almost all babies, breast is best. And breastfeeding is even better for the vast majority of those born premature. By working closely with hospital staff, you can ensure that your baby gets the best nutrition possible.
March of Dimes
Office on Women’s Health
Canadian Breastfeeding Foundation
Caring for Kids—Canadian Paediatric Society
Breastfeeding. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated May 13, 2016. Accessed June 15, 2016.
Breastfeeding your baby in the NICU. March of Dimes website. Available at: http://www.marchofdimes.org/baby/breastfeeding-your-baby-in-the-nicu.aspx. Updated August 2014. Accessed June 15, 2016.
Feeding the premature infant. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated May 12, 2016. Accessed June 15, 2016.
Is breastfeeding important for my premature baby? La Leche League International website. Available at: https://www.llli.org/faq/premimportant.html. Updated January 10, 2016. Accessed June 15, 2016.
Providing breastmilk for premature and ill newborns. American Academy of Pediatrics Healthy Children website. Available at: http://www.healthychildren.org/English/ages-stages/baby/breastfeeding/pages/Providing-Breastmilk-for-Premature-and-Ill-Newborns.aspx. Updated November 21, 2015. Accessed June 15, 2016.
Last reviewed June 2016 by Michael Woods, MD
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