Breastfeeding a Premature Baby 👶
World Breastfeeding Week
World Breastfeeding Week is a global campaign that is celebrated every year during the first week of August in several countries across the world. In 1992, the first World Breastfeeding Week was celebrated. The theme of World Breastfeeding Week 2020 was “Support breastfeeding for a healthier planet”.
In line with this theme, WHO and UNICEF are calling on governments to protect and promote women's access to skilled breastfeeding counselling, a critical component of breastfeeding support.
Early nutrition support is recognized as critical to growth and development and exclusive breastfeeding is universally recommended as beneficial to the health and well-being for all infants. Breastfeeding provides every child with the best possible start in life. It delivers neonatal immunity, nutritional and emotional benefits to both children and mothers. It decreases stress levels and improves mother-child bonding.
But while breastfeeding is a natural process, it is not always easy. Mothers need support – both to get started and to sustain breastfeeding.
UNICEF Executive Director Henrietta H. Fore and WHO Director-General Tedros Adhanom Ghebreyesus, in their joint statement put forth that , skilled counselling services can ensure that mothers and families receive breastfeeding support, along with the information, the advice, and the reassurance they need to nourish their babies optimally. This can instil into mothers, a sense of confidence while respecting their individual circumstances and choices.
Breastfeeding counselling can empower women to overcome challenges and prevent feeding and care practices that may interfere with optimal breastfeeding, such as the provision of unnecessary liquids, foods, and breastmilk substitutes to infants and young children.
Breastfeeding a premature baby
While celebrating World Breastfeeding week 2020, we at ‘ohlifesbeautiful’ talk about the importance of " breastfeeding a premature baby".
My second child, Aadi, was a premature baby and I had so many doubts whilst raising him. It has been a decade now. Looking back at those times, I had no one around me whom I could look upon to provide any direction. My family, friends and colleagues were always beside me but literally no one with any real life or practical experience, other than the technical expertise of the doctors and nurses.
I was frightened, anxious, depressed, guilty, and dead terrified, just as the seven other moms whose babies were in the NICU (Neonatal Intensive Care Unit). I broke down every time I went to Breast feed my baby on hearing the beeps of the ventilators, the high-power lights, and the connecting wires on my baby. I remember looking at the screen going up and down with his pulse beats.
I remember once a doctor consoling me to relax and go on to feed my baby as he said stress or being tense will reduce my milk. And ultimately that’s what happened, and which put me into further panic. But Neonatal care has come a long way since then, and thanks to the internet, you have lots of experiences to look into.
My baby too has stepped into his eleventh and with God’s blessings, is growing up into a fine lad. It has taken me all these years, this blog and a few of my young friends asking for advice in similar circumstances, to ultimately open up and prompted me to write down my long bottled up experiences, in the hope that it might at least be of help to many other moms to be. Because, I feel, even if you are surrounded by many people, with many different opinions, it makes it a lot easier to relate to and share with someone who has been through the experience themselves.
God bless all to-be moms, to have healthy babies and I certainly do not wish anyone to tread on the path that I walked. But life is so uncertain, hence let us light a candle as we move on, so that whoever comes behind us, their paths too light up.
Who is a premature baby?
A baby is classed as premature if he/she is born before 37 weeks of your pregnancy.
There are sub-categories of preterm birth, based on gestational age:
extremely preterm (less than 28 weeks)
very preterm (28 to 32 weeks)
moderate to late preterm (32 to 37 weeks)
Why are babies born prematurely?
There are several factors that increase the likelihood of premature delivery.
certain health conditions affecting the mother or foetus,
having had a premature baby earlier.
As premature babies have had less time in the womb, they have some extra growing to do, and are more vulnerable to illnesses and infections. They may also need to spend time in a neonatal intensive care unit (NICU).
Feeding your premature baby breast milk is especially important for a premature baby, however breastfeeding directly can be challenging.
Breastfeeding a preterm baby
Breast milk is important for the optimal growth and development of full-term infants, and it is even more important for premature babies. If your baby was very premature or weak, it might take a while before she will be able to suckle at your breast. In this case, you can express your milk and feed by tube, bottle, or spoon till she is ready.
Breastfeeding is important to preterm infants, as it seems to provide even more pronounced health benefits than to infants born at term age. Even if your baby cannot breastfeed yet, expressing breast milk from the beginning will ensure that your milk supply is maintained until your baby is able to nurse.
Why should a Premature baby be fed mother’s milk only?
Breast milk from mothers who have delivered early is different from breast milk from mothers who deliver at term, at least for the first several weeks, and this difference is designed to meet your baby’s needs. It also protects the baby from infection and illnesses.
Preterm milk is initially higher in protein, fat, free amino acids, sodium, and antibodies but over the first few weeks following delivery these levels decrease.
This milk provides some special factors to help baby’s immature immune system. Because they need more proteins for growth than full-term babies, your colostrum will have more protein. Among minerals, copper and zinc content are both higher in preterm milk than term milk and decrease over the time of lactation.
Important nutrients, such as DHA (a fatty acid vital for healthy brain and eye development) and immunoglobulin G (an antibody), are transported from mother to foetus via the placenta throughout pregnancy. Because they arrive early, premature babies have not fully received these important factors in the womb, but milk from mothers of premature infants contains more fats and secretory immunoglobulin. The fat in human milk helps to enhance the development of the baby’s brain and neurologic tissues, which is especially important for premature infants.
Premature babies also have immature gastrointestinal tracts, breast milk contains enzymes that help your baby with digestion, as well as epidermal growth factor, which in turn helps his intestine mature. A preterm mother’s milk will have more fat and less lactose, because premature babies find lactose hard to digest.
Does breast milk give preterms better outcomes?
A stronger association between breastfeeding and cognitive outcomes has been observed in studies of low birth weight infants. Studies have found that babies born before their due date show better brain development when fed breast milk rather than formula. Experts say that helping mothers to provide breast milk in the weeks after giving birth could improve long-term outcomes for children born pre-term.
Guiding a premature baby to suckle
Every mother who has delivered prematurely will relate to “Kangaroo care”. This approach of skin-to-skin contact supports development in preterm infants, as accelerated neurophysiological development has been reported in preterm infants receiving daily skin-to-skin contact. Skin-to-skin contact was defined as the infant – wearing only a diaper and maybe a cap and socks – lying on its parent's bare chest.
Continued skin-to-skin contact on a daily basis after incubator care was also associated with earlier establishment of exclusive breastfeeding. When your premature baby is ready to breastfeed, you might find that progress can be quite slow, especially if your baby was born very early or is very sick.
Feeding is a complicated skill, and premature babies get tired very quickly. During this learning time, your baby might suckle only a very small amount of milk from your breast, with the rest fed by tube. You will require a lot of patience, tenderness, and mental strength to cope with this stage.
Professional help and support could be sought for. The nursing staff or lactation consultant can help you with breastfeeding techniques and positions. However, do remember that it can take some premature babies a while to learn how to breastfeed.
During the present COVID-19 pandemic, it is even more important to find innovative solutions to ensure that access to these essential services is not disrupted and that families continue to receive the breastfeeding counselling they need. Mothers should continue breastfeeding as it is pivotal for strengthening child’s immunity.
Lactating mothers should be careful about their diets too, as it will have an impact on the breastfed baby. They should take a balanced diet with wholesome foods such as whole grains, dried and fresh fruits, vegetables, legumes and pulses, eggs and chicken and also drink a lot of water, fresh fruit juices, tender coconut, lassi and lime juice to maintain the right level of hydration.
Boyd, C., Quigley, M., & Brocklehurst, P. (2007). Donor breast milk versus infant formula for preterm infants: Systematic review and meta-analysis. Archives of Disease in Childhood: Fetal and Neonatal Edition, 92(3), F169-175. doi: 10.1136/adc.2005.089490.
Cristofalo EA, Schanler RJ, Blanco CL, Sullivan S, Trawoeger R, et al. (2013) Randomized trial of exclusive human milk versus preterm formula diets in extremely premature infants. J Pediatr 163(6): 1592–1595.
Heikkilä, K., Sacker, A., Kelly, Y., Renfrew, M.J., & Quigley, M.A. (2011). Breast feeding and child behaviour in the Millenium Cohort Study. Archives of Disease in Childhood, 96(7), 635-642. doi: 10.1136/adc.2010.201970.
Hoddinott P, Tappin D, Wright C (2008) Breast feeding... BMJ 336: 881–887.
Koo, W., Tank, S., Martin, S. et al. Human milk and neurodevelopment in children with very low birth weight: a systematic review. Nutr J 13, 94 (2014). https://doi.org/10.1186/1475-2891-13-94
Morley R, Fewtrell MS, Abbott RA, Stephenson T, MacFadyen U, et al. (2004) Neurodevelopment in children born small for gestational age: a randomized trial of nutrient-enriched versus standard formula and comparison with a reference breastfed group. Pediatrics 113(3 Pt 1): 515–521.
Niela-Vilen, H., Axelin, A., Melender, H-L., & Salantera, S. (2015). Aiming to be a breastfeeding mother in a neonatal intensive care unit and at home: A thematic analysis of peer-support group discussion in social media. Maternal and Child Nutrition, 11(4,) 712-726. doi: 10.1111/mcn.12108.
Nyqvist, K. (2008). Early attainment of breastfeeding competence in very preterm infants. Acta Pædiatrica, 97, 776-781. doi: 10.1111/j.1651-2227.2008.00810.x.
Quigley, M.A., Henderson, G., Anthony, M.Y., & McGuire, W. (2014). Formula milk versus donor breast milk for feeding preterm or low birth weight infants. Cochrane Database System Review 2014, 4, CD002971. doi: 10.1002/14651858.CD002971.pub3.
Quigley, M.A., Hockley, C., Carson, C., Kelly, Y., Renfrew, M.J., & Sacker, A. (2012). Breastfeeding is associated with improved child cognitive development: A population-based cohort study. Journal of Pediatrics, 160(1), 25-32. doi: 10.1016/j.jpeds.2011.06.035.
Scher MS, Ludington-Hoe S, Kaffashi F, Johnson MW, Holditch-Davis D, et al. (2009) Neurophysiologic assessment of brain maturation after an 8-week trial of skin-to-skin contact on preterm infants. Clin Neurophysiol 120(10): 1812–1818.
Rønnestad A, Abrahamsen TG, Medbø S, Reigstad H, Lossius K, et al. (2005) Late-onset septicemia in a Norwegian national cohort of extremely premature infants receiving very early full human milk feeding. Pediatrics 115(3): e269–276.
Underwood MA. Human milk for the premature infant. Pediatr Clin North Am. 2013;60(1):189-207. doi: 10.1016/j.pcl.2012.09.008
Wechsler Linden, D., Trenti Paroli, E., & Wechsler Doron, E. (2010). Preemies: The essential guide for parents of premature babies (2nd edn). New York: Simon & Schuster.