Click here for shortcuts to regional language blogs and city-specific events.
Human milk is recognized as the optimal feed for all infants because of its proven health benefits to infants and their mothers and the same holds true for the premature babies in NICU as well. However, mothers of vulnerable infants, such as preterm infants, encounter a variety of unique breastfeeding barriers and challenges that result in a decreased rate of breastfeeding in preterm compared with term infants.
Due to their immaturity, infants who are born early face challenges with the respiratory, cardiovascular, neurological, immunological, hepatic, renal and gastrointestinal systems. Those born at 25 weeks are significantly less developed compared to those born at 30 weeks and subsequently are more susceptible to these issues.
Benefits of human milk for premature infants ~ Advantages of using breast milk in premature babies as compared to the formula milk
For many of these outcomes there appears to be a dose response effect of human milk feeding and hence all efforts should be made to give whatever human milk either from the same mother or donor human milk from the milk bank and supplement with formula only if required.
Despite the numerous advantages of human milk to the premature babies, most babies are not able to get enough because mothers are not able to maintain adequate production in absence of direct sucking by the infant. Reduced milk production by mothers can be helped by ensuring new mothers should begin frequent pumping shortly after delivery. Mothers whose babies are in the NICU should be encouraged to begin pumping within first 6 hours of delivery and to pump 8 – 12 times per day, ensuring that they empty the breast each time. Use of hospital grade breast pumps during this time is advantageous. In addition mother’s diet should not be restricted as is the tradition in our country especially after the caesarean section. Talking to a lactation counsellor may also help produce more quantity of milk. Doing Kangaroo mother care to the babies also has been linked to increased breast milk production by the mothers.
There are concerns that breast milk is not adequate for the growth of the premature baby especially the very premature babies as the demands of the minerals and proteins in such babies is significantly higher than the term babies. Human milk evolved/was designed to nourish the term infant who can tolerate large fluid volumes, whereas premature infants are less tolerant of high fluid volumes. For these reasons, human milk is generally fortified for premature infants with birth weight less than 1500 grams. Human milk fortifier powders were developed from bovine milk to supplement key nutrients with particular emphasis on protein, calcium, phosphorus, and vitamin D. Your doctor would suggest the right human milk fortifier for addition to breast milk for better growth.
For those children who don’t have the advantage of having mothers own milk there are milk banks similar to the blood banks which supply the pasteurized donor human milk collected from the voluntary donors (this is free from infection). All professional bodies including WHO suggest that this is second best option for feeding premature babies in case mother’s own milk is not available and is better than formula. Fortunately, the number of milk banks been set up in India is increasing and is a valuable move toward improving survival of premature babies.
The earliest postmenstrual age (PMA) at which preterm infants can successfully take direct breast feeding from the mother is uncertain. Oral feedings often are initiated at 33 to 34 postmenstrual weeks. Oral behaviours, such as non-nutritive suckling (i.e. suckling at an emptied breast) and rooting, appear to be better indicators of readiness to feed. Suckling at an emptied breast promotes non-nutritive sucking while providing maternal nipple tactile stimulation and bonding that may increase milk production. A mother can use these opportunities to observe her infant's behaviour and track his/her developing oral skills as an indication of readiness for oral feeding. Suckling is initiated by placement of the infant at the breast after the mother expresses milk. Although the infant should be held in proximity to the breast, no attempt should be made to ‘position’ the infant's mouth and gums over the nipple and areola. Instead, licking and suckling on the nipple tip is all that is expected during these initial sessions. Positioning the small, preterm infant for suckling or feeding at the breast is best achieved by using the clutch (also known as the football) or cross cradle (across the lap) holds.
In conclusion, human milk based feeding has numerous advantages for the survival of preterm infant and must be preserved in today’s world. If mother’s own milk is not available then pasteurized human milk from the milk bank is a good alternative and definitely much better than using formula milk. Limitation of human milk regarding the growth of preterm babies can be overcome by using human milk fortifiers. Increased efforts to establish and maintain milk supply in women delivering preterm are likely to have great benefits.