Must-read information on breastfeeding your preemie
Is it possible to successfully breastfeed your premature baby? It is, when you are armed with the correct knowledge and expert advice brought to you in this article…
Most parents are aware of the many advantages of breastfeeding full-term babies.
The World Health Organization (WHO) recommends exclusive breastfeeding for the first six months of a baby's life. Breastmilk is the gold standard nutrition for babies and has a wide range of benefits including increased immunity for baby, enhanced bonding between mother and child, and decrease in risk of breast cancer for the mother.
If you are a mum of a preemie however, you may be wondering if all these benefits for full term babies still hold true or if breastfeeding your little delicate one is still possible. You'll be happy to find out that the answer is "YES".
In this article, we review the clinical benefits of breastmilk for preemies. We also invite Mrs Wong Boh Boi, Senior ParentCraft Educator of Thomson Medical Centre, to weigh in on tips for successful breastfeeding for preemies.
Your breastmilk is still best
Breastmilk is an incredible source of food for any baby. It is tailor-made to suit your child's nutritional needs and will keep changing according to your little one's changing nutritional requirements. As the mum of a preemie, it's no different when it comes to your own breastmilk.
Your body knows that your baby was born prematurely, and as such, will make milk that is more suitable for your little one's increased nutritional needs.
According to a large and established body of research conducted by experts such as the American Academy of Pediatrics, La Leche League International (LLLI) and the National Health Centre (NHS), UK, preterm breastmilk will actually be higher in most nutrients such as protein, fat, calories and other micronutrients -- with the exception of calcium and phosphorous -- than the milk of a full term baby's mother.
However, within a few weeks, the nutritional content of a preterm mother's breastmilk will be closer to that of a term mother's breastmilk.
Your breastmilk also plays an important role in protecting your vulnerable preemie from infections, by providing him with immunoglobins (antibodies). With a full-term pregnancy, immunoglobins are usually transferred across to the baby via the placenta in the final trimester of pregnancy, according to neonatal experts.
What is human milk fortification and how can it help your preemie's nutrition needs? Find out on the next page.
Human milk fortification
While breastmilk, without a doubt, is the ideal nutrition for preterm babies, a preemie could require extra energy, protein, fat, minerals, and vitamins beyond what a mother’s milk can provide.
The reasons for these often higher nutrient needs are many, ranging from low nutrient reserves, incomplete absorption due to immature metabolism to increased need for rapid growth.
In fact, the European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESGPHAN) advocates the use of human milk for preterm infants as standard practice, provided it is fortified with added nutrients where necessary to meet the preterm baby’s requirements.
The fortification of breastmilk provides preemies with additional calories, protein and vitamins and minerals such as calcium and phosphorous. The latter minerals are crucial for bone building.
Studies have shown that preemies who receive better nutrition early in life, achieve proportionate growth, with gains in weight, length and head circumference. Their long-term health is also improved with regard to neurodevelopmental outcomes.
Do have a chat with your preemie's doctor about breastmilk fortification depending on your little one's unique nutritional and developmental needs. Neonatal Intensive Care Unit (NICU) nurses will show you how to fortify your breastmilk accurately to support the growth of your little one.
Breastfeeding your newborn preemie ― is it possible?
A full-term infant is usually able to latch on to his mother's breast almost immediately after birth. However, this may not be the case with a premature baby, who may not be able to suckle or swallow as vigorously as a full-term infant.
Many hospitals start off feeding preemies expressed breastmilk through a nasogastric (NG) tube (known as gavage). This ensures that your little one is getting adequate nourishment if he's unable to feed directly from you.
Whether you can direct-latch your baby on your breast soon after birth also depends on how early he was born. However, this doesn't mean that your baby cannot get the benefits of your breastmilk.
On the next page, read some great tips that will help you breastfeed your preemie successfully.
Tips to encourage breastfeeding success
Here are some great practical tips to help get you started with and continue breastfeeding your preemie:
- Start expressing ideally within about six hours after giving birth. Plan to pump about eight times per day, every two to three hours during the day and every three to four hours at night. Use a good quality electric pump and/or proper hand expressing techniques to help establish your supply. Whether your baby is fed directly via tube or syringe, spoon, bottle, breastmilk should be used.
- Hold your baby in a breastfeeding position if he is being tube-fed.
- If your baby is born before 32 weeks, the NICU nurses will help him learn to suck and swallow by using a dummy nipple so he can transition to oral feeding as soon as possible.
- Ask to practice kangaroo care if the hospital doesn't suggest it. This method involves your baby wearing only a nappy and hat, and being placed against your skin underneath your clothing. Your baby has unrestricted access to your breasts this way, which helps establish breastfeeding. What's more, it's likely that your expressed breastmilk supply will increase by an average of 50%. Your little one will also show an improved suckling ability, thought to be due to the stimulation of being near your breasts.
- Experiment with different breastfeeding positions. Try the "twin position," “football position", or "cross cradle position”. Mrs Wong suggests that if your preemie’s jaw muscles are a little weak, you could try the “dancing hand position” which is said to work well with preemies. It involves tucking your baby under your arm with his body supported by a pillow.
- Encourage your let-down reflex before putting your baby to the breast by massage, hand expressing, or putting a warm cloth or heat pack on your breast. Be mindful not to get scalded by the heat pack.
- Spend time with a lactation consultant. She will be a wealth of information for all things breastfeeding related and will be able to advise you on different nursing holds, how to encourage your baby to latch properly, as well as sort out any breastfeeding difficulties you may face.
- While still in hospital, Mrs Wong recommends getting as much help as possible from all medical staff to help your preemie to achieve a proper latch. They can use breastfeeding assessment tools like LATCH and IBFAT to ensure that baby is emptying your breasts effectively, and to achieve successful breastfeeding for a longer duration.
- Join a support group. Ask doctors or nurses at the hospital if there are support groups they can recommend. You could also join an online social media group such as the Breastfeeding Mums Support Group on Facebook.
- Stay in touch with your baby’s doctors and nurses and your lactation consultant. They can reassure you about your baby’s progress and talk you through any nutrition or nursing issues you may encounter.
How many times a day does a preemie need to feed? Find out on the next page.
Preemie nursing patterns
Full-term newborns generally need to nurse from eight to around 12 times a day.
When it comes to your preemie however, neonatal specialists say that feeding patterns differ between babies and vary from day to day. Usually, most preemies need to feed every 2 1/2 to four hours. This also is dependent on the baby’s body weight, gestational age and if the “suck and swallow reflex” is present.
Look out for hunger cues, too. Your little one may not always cry like a full-term baby to express hunger, but he may move around and become restless if it has been around two to three hours since his last feeding.
The NICU nurses of your hospital can also give you an idea of your little one's feeding pattern before he is discharged. Often, the doctor will advise you to wake your baby up and nurse him if it has been longer than four hours since the last feeding.
How much breastmilk should a preemie drink?
According to experts at the International Breastfeeding Centre, many NICUs around the world have a rule that preemies can receive only a certain amount of liquid a day―usually around 150 to 180 ml/kg/day, sometimes less.
However, every preemie, including yours, will have unique needs. So, when figuring out how much breastmilk your little one should be drinking and how often, it's best to speak to NICU staff first for advice. This is because neonatologists usually use complex equations to decide how many calories a preemie should get for good growth.
They should be able to calculate your own baby's calorie needs and, based on this, let you know how often and how much you should be feeding him.
Once you take your preemie home and establish your breastfeeding routine, you'll know he is getting enough to eat if he looks healthy and is growing well. Your paediatrician will also be able to advise you on your little one's growth when you take him in for his regular check-ups.
Mums, we understand―getting a proper breastfeeding routine for your preemie established may be a frustrating experience sometimes. But with perseverance and proper guidance, you can successfully go on to give your little one the best head start in nutrition possible with your breastmilk.
Nearly 1 in 10 babies in Singapore is born premature. Support prematurity awareness by sharing this with other mums and mums-to-be. Continue to follow the DreamBig series, especially for parents of premature babies and pregnant women. The next article will discuss understanding and developing your preemie's senses and communication.
The material is for informational purposes only and is not intended to replace medical advice of a qualified healthcare professional.
Do you have experience in looking after a preemie? If you do, please share your useful tips with other parents by leaving a comment below.