Everything you should know about breastfeeding a premature baby

A breastfeeding premature baby has a higher chance of growing faster than those fed formula or given other sources of nutrition.

If you are a first-time mother, you already have a lot on your plate. But if your baby happens to be premature, then that will come with it own set of unique challenges.

And one of your biggest concerns will be breastfeeding your premature baby. 

Breastfeeding premature baby: All you need to know

Typically, a preemie is cared for in a neo natal intensive care unit for help with respiration, fluid loss, temperature regulation and most importantly, nutrition.

Many of your preemie's basic movements such as suckling, latching, holding on the breast, swallowing as well as breathing might still be underdeveloped. This makes breastfeeding extremely challenging.

But while nursing is essential for all babies, it is even more crucial for those born before time and so underdeveloped. 

Why is breastmilk crucial for my premature baby? 

In a premature birth, your breastmilk takes over the job of the placenta and continues to help in the baby's growth and development. That's because your hormones naturally help you produce breast milk that has essential nutrients, vitamins, minerals and proteins that can nourish the preemie.

In fact, the milk produced by your body for your preemie also contains high concentration of sodium, phosphorus, chloride, protein, iron, fat calories as well as magnesium. All of these are essential for optimal growth and development of a premature baby and also aid his bowel movements. 
 
But there are more advantages of breastfeeding such babies immediately.  

  • Breast milk has antibodies, anti-inflammatory factors and live cells that help your premie develop a stronger immunity because a premature baby has naturally low immunity and faces a higher risk of infection as compared to a full-term baby.  
  • It is easy to digest as compared to formula and because it already works towards better immunity, it helps in gut protection as well. 
  • Your breast milk also contains growth factors for the brain as well as for the body and works on better bone density

And even though you can rely on formula feeding, it may not be the best choice.

That's because with industrial formula you increase the risk of asthma, necrotising enterocolitis (NEC –a fatal bowel condition in preemies), allergies, Sudden Infant Death Syndrome (SIDS), heart disease as well as meningitis.    

But how soon must you start nursing your preemie is perhaps the most important concern. 

When should I start breastfeeding premature baby? 

This can be divided on the basis of the age / weeks of your preemie.

  1. At 28 weeks, your preemie may briefly latch on for a few sucks because by this time his rooting reflex becomes strong. However, coordination is yet to develop, and therefore, breastfeeding would still be tough.
  2. Between 30 and 32 weeks, your preemie will be able to swallow milk from your breasts. And as he inches closer to 32 weeks, he will be able to suck, swallow as well as breathe- all the movements essential for a good latch and proper feeding.  
  3. By the 34th week, your preemie will be able to breastfeed like any other newborn. His coordination will have improved and he will be able to support his breathing while sucking and swallowing breast milk.

But if you follow kangaroo care and a few other methods to help your preemie grow and develop, he can feed earlier as well. 

breastfeeding premature baby Kangaroo care is a method wherein the preemie is kept in a skin-to-skin contact with the mother and ideally fed breast milk, exclusively

What should I do to help my preemie breastfeed? 

  • Kangaroo care: Your health care provider will advise you to begin the process with kangaroo care. This is recognised as the best care for a preemie by the World Health Organisation (WHO) and helps to stabilise his heart rate as well as oxygen levels in the body. It also prepares him for breastfeeding and is instrumental in brain development. For the uninitiated, kangaroo care is a method wherein the preemie is kept in a skin-to-skin contact with the mother and ideally fed breast milk, exclusively.   
  • Continuous skin-to-skin: It is best that your preemie is given as much skin-to-skin contact as possible. This means even when he receives medical support like ventilation, continuous positive airways pressure (CPAP), intravenous fluids as well as given treatment for jaundice or any other medical condition. Keeping him on a bare chest will help your preemie stabilise more quickly and your doctor will help you set him up in the correct position so his breathing is not compromised. 
  • Express your milk: If you are not feeding your preemie almost immediately, then it's best you hand express within an hour of giving birth. Follow it up with pumping or hand expressing every two hours. Your goal should be to pump 750­­–1000ml in the first week so there is enough for your preemie. If your preemies are twins, the volume will double. Remember, your breast milk is the most important nourishing agent and must be given to your preemie soon after birth. 
  • Use alternative methods to feed: If breastfeeding looks challenging, there are other ways to feed your baby. They may progress from parenteral nutrition (intravenous feed in the veins), to tube feeding by nose or mouth- naso or oro-gastric tube (NGT, OGT) to cup feeding and finger feeding and finally the breast. It depends on whether your milk has come and if your baby is able to suck and swallow the breast milk.  

Now, as weeks progress and you help your preemie breastfeed better using the aforementioned methods, his weight will also increase.

The WHO lists the following ideal weight for a growing preemie. 

  •  20g/day up to 32 weeks of post-menstrual age, corresponding approximately to 150-200g/week;

  • 25g/day from 33 to 36 weeks of post-menstrual age, corresponding approximately to 200-250g/week;

  • 30g/day from 37 to 40 weeks of post-menstrual age, corresponding approximately to 250-300g/week.

However, if your baby is not growing at the rate suggested by WHO (although not all babies are the same and their weights may naturally vary), you may want to check the fat levels in your breast milk. Yes, you read that right! 

breastfeeding premature baby It is crucial to also check the fat levels in breast milk while breastfeeding premature baby

How can I improve my preemie's weight?   

Even though you are producing enough breast milk for your preemie, you may feel that he is not gaining as much weight as he should. This could be due to low fat levels in the breast milk. 

However, there is no need to worry. You can raise the fat levels of your breast milk, thereby, naturally raising its calorific value. 

  • Breast compression: Ideally, the fat content in your breast milk increases at the end of the feed. So try to use breast compression (squeezing the breast to stimulate mammary glands and to increase milk supply). This can help release fat in breast milk. 
  • Evening feeds: Some studies prove that breast milk that comes in the evening has higher fat content or higher calorific content. So you can pump additional milk and store it for the next few feeds, if possible. 
  • Centrifuging breast milk: This is a medical process that can only be performed in milk banks, however, you must know about this as well. Milk is centrifuged at a low speed to obtain a high fat cream layer. This layer is then resuspended so as to obtain the desired calorific value in breast milk.   
  • Human milk fortifiers: In addition to breast milk, your preemie may also be given 'human milk fortifiers (HMF).' They are commercially prepared multi-nutrient fortifiers that are cow-milk-based. They act as supplements to breast milk and often given to preemies. However, not all preemies need HMF and if you are able to produce breast milk then no additional nutrient is required for your baby.
  • Donor breast milk: Another method to feed the baby in case your breast milk is not enough is to opt for pasteurised donor breast milk that is available in milk banks. It is much better than formula feeding a preemie because it also has similar if not the same nutrients as your breast milk and is a good boost till your own supply comes back.  

What else should I bear in mind when breastfeeding premature baby? 

Apart from keeping a close watch on your baby's weight and the quality of your feed, you must also keep an eye on the following. 

  • Feed frequency: The frequency of feed is crucial in aiding your preemie's growth. After consultation with your doctor you may be told that a feed every 60-90 minutes is ideal, but that again depends on your preemie's health condition as well as requirement. 
  • Preemie sleeping between feeds: It may be tiring for your small preemie to feed every hour round the clock, but it is also quite relaxing and reassuring for your baby, so do not be discouraged. Continue to feed your baby and give him as much skin-to-skin contact as possible.
  • Avoid pacifiers: Generally it is best to avoid pacifiers because skin-to-skin is the best way to soothe a preemie and help him get used to the breast, Pacifiers can be used in case they are doctor recommended and also the only things that keep your preemie relaxed. 

Remember that a breastfeeding premature baby has a higher chance of developing and growing faster than those fed formula or given other sources of nutrition. So even if you are short on supply, do not worry.

Try different methods to increase your supply such as galactagogues (foods and herbs that help increase milk supply) as well as hand compression.

Most importantly, be patient and give your baby as much skin-to-skin as contact. 

Sources: breastfeeding.support, WHO, bellybelly

Also read: The importance of optimal nutrition for premature babies

(All images courtesy: Pixabay, Flickr, Wikimedia)