Breastfeeding a Premature Baby

Breastfeeding Premature

OK, you’ve read about the advantages of breastfeeding and are on board with nursing your soon-to-be-born infant.  Then, without warning, he is born a few weeks early.  He’s doing OK, but due to his prematurity, he needs some special attention in a neonatal intensive care unit (NICU).  Furthermore, he won’t be able to eat for a couple of days and will be receiving fluids and nutrition through a vein.

In a situation like that—with so many unplanned questions—all thoughts of breastfeeding may be relegated to the back burner.  Yet due to “breast being best,” NICUs have begun efforts to keep breastfeeding front and center.  And at least one study shows that while there’s still some work to be done, breastfeeding in NICU babies is on the rise.

Giving a premie breast milk is not without its challenges.  Yet it can be of even more benefit to a premature baby than it is to a term baby.  Let’s look a little bit at why it’s important to consider breastfeeding, what bumps in the road Mom and Baby might encounter, and what everyone who cares for a premie might do to make things go more smoothly.

Why All This Talk About Breastfeeding, Anyway?

Pediatricians have been talking about the benefits of breastfeeding for decades.  And in comparing breast to formula feeding, they tell parents that breast milk is the optimal nutritional balance for their baby, is more digestible, and provides infection-fighting antibodies.  There also appear to be considerable benefits for Mom.

Many of the advantages that breast milk lends to infants are particularly beneficial for newborn premies.  They have immature digestive systems that benefit from a feeding that is more easily digested.  They’re more prone to infection, making Mom’s antibodies particularly helpful in fighting disease.  Finally, they’re at risk for some diseases that term babies don’t get—for example, a serious bowel disease known as necrotizing enterocolitis

What’s more, the composition of premature breast milk appears to be a little different—actually tailored to an early baby’s special nutritional needs.  It’s higher in protein and minerals, which is especially important for her bones.  And the type of fat in premie milk is especially digestible.

Special Premie Challenges…

Probably the biggest impediment to breastfeeding is not being able to feed by mouth at all.  Some premature babies, particularly those that are extremely premature or have other medical problems such as an infection, may not be able to take anything by mouth for days—due to breathing problems, for example.

Even premies that don’t have such problems may not be able to feed well.  The nerves and muscles necessary for successful nursing are not normally well developed until about 33 to 34 weeks gestation (6 to 7 weeks before due date).  Also, a mother’s milk production may be less with a premature infant.  Add to that the increased nutritional needs of a premature infant and a you have a potentially challenging situation.

…And How the NICU Deals with Them

Because of the clear advantages of breast milk in premies, NICUs are getting better and better at encouraging Moms to go the breastfeeding route.  Since a premie mother’s milk supply is already somewhat diminished, discussions take place early; it’s recommended that breast milk be expressed as early as six hours of life.  Lactation specialists and efficient electric breast pumps are increasingly available, setting the stage for successful milk production and, later, nursing.

In addition to helping mothers express milk early, NICU policies now have premature babies—even those with some problems—take it early.  Even swabbing the mouth with Mom’s infection-fighting early breast milk (colostrum) is helpful.  In many cases, breast milk is given by feeding tube—as early as Day #1 when possible.

As a premie gets older and his condition improves, he’s brought to the breast.  Here, too, the lactation specialist can offer lots of support.  And for infants that don’t appear to efficiently breastfeed right off the bat, there are helps.  Some examples:  having a premie nurse on an empty breast, having mother express a little milk first before nursing, and using a nipple shield.

For infants that absolutely can’t nurse enough to fulfill their nutritional requirements, or for the uncommon extremely premature baby that needs more nutrients than breast milk can provide, giving human milk by bottle or cup provides the benefits of breastfeeding.  Very low birthweight babies will often have human milk fortifier added to their breast milk.  This provides extra protein, calories and minerals.  And most premies will be given supplements of Vitamin D (now recommended for all breastfed infants) and iron, two nutrients that are present in smaller amounts in breast milk.

Although having a baby unexpectedly early—especially one with some medical problems—is never an easy thing for parents to go through, there is good news for parents who expected their new arrival to get her nutrition from breastfeeding.  Neonatal professionals know that it’s a stressful time for parents, and while you’re receiving lots of information about your baby, they’ll not lose sight of the importance of breastfeeding.  They’ll do all they can to discuss the “why”, “when” and “how” so your little one can reap the advantages that breast milk can provide.

Stan Sack
Dr. Stan Sack has 29 years’ experience as a primary care pediatrician in Massachusetts and Florida. A medical writer since 2015, he enjoys blogging on topics that are on parents’ minds but are covered less often in books and on websites. He lives in the Florida Keys with his family and enjoys healthy cooking, fitness activities and singing in his spare time.

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