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 pressure. Depending on which complications arise, a premature baby’s nutrition may initially take a backseat to the larger issues. Breast milk, though, has been shown to play a crucial role in improving the health of premature infants.

The Importance of Breast Milk

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 directly into the stomach. But 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. Breast milk also contains proteins that promote growth, helping preemies grow at a faster rate than full-term babies.

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 artificial milk were more likely to develop NEC than infants fed breast milk. Some studies have suggested that premature infants fed breast milk were less likely to develop any kind of infection—including the potentially devastating infectious condition called meningitis. Mental and psychomotor skills have also been studied, and premature infants who received breast milk showed improved cognitive development compared with those fed artificial formulas.

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.

Pumping Breast Milk

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. Experts suggest pumping as soon as possible, preferably within the first day. This is because colostrum, the very 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 experts recommend persisting through the fluctuations because consistent pumping (every 2-2.5 hours during most of the day, with sleep or work breaks of no longer than 8 hours) will lead to a well-established supply.

Pumped breast milk is divided into two categories: foremilk and hindmilk. Foremilk is the milk expressed during the first half of the pumping session. Hindmilk is expressed during the last half of the pumping session. Hindmilk has been suggested to be the preferred milk for preemies since its fat content is up to three times higher than foremilk.

Transitioning to Breastfeeding

Research points to 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), nonnutritive sucking on both the pacifier and the breast, and avoidance of bottles during the transition process.

Once your baby is ready for breastfeeding you will notice signs. Rooting is one such sign: stroking the baby’s cheek results in him turning his head in the direction of your hand with his 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.

Premature babies who are used to being fed through a tube may experience some difficulty when first learning to breastfeed. Oral aversion is one such difficulty; this occurs when a baby associates unpleasant sensations with his mouth because of presumed unpleasant experience with feeding or breathing tubes. Introducing pleasurable sensations to the baby’s mouth, like placing some breast milk on the baby’s lips or gently stroking his mouth and cheek can help overcome this problem.

Another difficulty is tongue thrusting, which is when infants continually thrust out their tongue while trying to latch on to the breast. Certain feeding techniques, such as having the baby feed with his chin pointed down or gently pressing the tongue down, can be taught by a lactation specialist. Finally, very premature babies may have trouble coordinating their sucking and swallowing, a recipe for feeding failure and even for aspiration of milk into the baby’s lungs. In most cases, coordination of sucking and swallowing improves with increasing maturity.

Thinking Ahead

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.