Wait, is this a booby trap? No, I am not a diehard breast bully and I am not here to try and convince you or guilt you into giving your baby breast milk. But being a NICU nurse has made me somewhat of a “lactavist”, and I can tell you first hand that I have seen the difference providing breast milk to a premature baby can make. This article will hopefully give you the information and the knowledge you need to make an informed decision on this aspect of your preemie’s care.
Medical and scientific advancement have come a long way in the world of preemie care. However, no matter how advanced it gets, the NICU can only try and replicate what nature does the very best within the womb, the growth and development of the baby.
This is also true when it comes to the nutritional needs of the newborn. Many medical and scientific advances have brought infant formula companies far in trying to replicate mother’s milk, and yes, they are good at what they do, but they will never be able to do what natures does best.
When your baby is born prematurely you may not have had time to think about and prepare your thoughts on whether or not you want to breastfeed your baby. You may even wonder with a premature baby, is still a possibility? Having a preemie often evokes feelings of helplessness, powerless, and loss of control. But there is comfort in knowing that you, and only you can pump and provide breast milk that was specifically made for your baby. This can give you back some of that power! There is great satisfaction in knowing that you are giving your baby the very best possible nutrition available to help them grow, thrive and strive.
Healthy term newborns breastfeed early and often and because of this a good milk supply is usually established. But when a baby is born prematurely, and breastfeeding isn’t initiated right away, a mother’s milk supply may be affected. It is important to pump early and pump often, with a recommendation to pump 8 times in 24 hours- every 2 to 3 hours in the day and every 3 to 4 hours at night. This can be an overwhelming thought and can be very time consuming and tiring. The stress and exhaustion that accompanies being a preemie parent can interfere with the ability and even desire to establish and maintain a good milk supply. Proper rest, nutrition, NICU and family support can make all the difference.
Human milk is considered the perfect food and the very best of infant nutrition for full term newborns. It contains all the nutrients, antibodies, and calories a baby needs in order to develop and grow. When a baby is born prematurely, nature actually makes breast milk that contains greater amounts of nutrients that are specific to a preemies needs. Research has shown that preterm breast milk is higher in fat, calories, proteins, immunoglobulins, calcium, phosphorus, zinc, and white blood cells.
The premature infant’s immature digestive has an easier time digesting breast milk because of the protein, fat, carbohydrate composition, and the proteins are quickly and completely absorbed. Human milk contains something called epidermal growth factor (EGF) which simulates the growth of the cells that line the intestines, making them more efficient at digesting the food. The immature lining of the premature intestines makes it hard for them to digest fat, which is essential for growth. Human milk contains an enzyme called lipase that helps break down the fat in the intestines so it is more easily absorbed. Premature intestines also have decreased lactase, which is an enzyme that helps digest carbohydrates and sugars. Breast milk contains lactase that helps aid in this digestion making it easier for the baby to absorb the nutrients needed for growth and development.
Breast milk contains good bacteria with over 130 oligosaccharides that are specific to human milk. These good bacteria help colonize the premature baby’s gut with friendly, healthy live cells and antibodies that help the growth of good pathogens and help to protect against severe intestinal inflammation and an infection called Necrotizing Enterocolitis (NEC) that can be devastating to a premature baby.
Colostrum, a thicker yellow fluid is the first milk that is produced during the first few days after the baby is born, is the super food for the immune system. Colostrum is easy to digest and stimulates the digestive system to mature. Colostrum contains high concentrations of protein, fat, vitamins, minerals, infection fighting white blood cells, and germ fighting proteins called immunoglobulin. Immunoglobulins act as antibodies that coat the lining of the immature intestines, and helps prevent the invasion of germs. Preterm milk has two times the amount of immunoglobulin of term milk. Research has also shown that mother’s who deliver very preterm infants actually produce colostrum longer than those who deliver at term. Preterm colostrum has the highest concentration of antibodies and is very high in concentrations of human growth factors, anti-inflammatory and anti-infective components, which help mature the premature baby’s intestinal lining.
Breast milk also has special types of fats that aid in the development of the brain and eyes. A brain building amino acid called taurine is found in larger amounts in breast milk than in formula. Taurine is an essential amino acid that aids in retinal (eye) development, increased visual acuity, and builds brighter brains. Breast milk also has larger amounts of brain building polyunsaturated fatty acids called DHA and ARA. These are commonly known as the smart fats. These smart fats are important for production of myelin, which is the fatty layer that insulates the nerves. DHA and ARA help the preemie’s immature brain grow faster, just like it would have in the last few months and weeks of pregnancy.
When a baby is born prematurely their digestive system is immature and (depending on how early) they can’t begin to feed by mouth right away. Babies born before 32-34 weeks cannot directly feed from the breast or bottle because they often don’t have the strength and their ability to suck swallow breath is not fully co-ordinated yet. Babies born before 28 weeks gestation have will receive most of their nutrition through something called Total Parental Nutrition (TPN). Parental means that the nutrition is given outside of the intestinal system. TPN is nutrition given intravenously and contains proteins, sugars, fats, vitamins, and minerals. Enteral feeding means giving the baby nutrition directly into the stomach and intestinal system. In premature babies this is done slowly to ‘prime the gut’ and get the digestive system ready to function properly. These feedings are medically called trophic feeds. Trophic feeds do not provide enough calories to meet the nutritional needs of the preemie, but they promote and stimulate the digestive tract and intestines to start functioning correctly. Feedings are often started through a small tube either in the nose (called NG tube) or the mouth (OG tube). Tube feeding are started when the GI tract is mature enough to handle food but the baby is not developmentally ready to take in nutrition by mouth. The use of tube feedings eliminates the energy expenditure that is used while eating orally. Premature babies require more energy to meet the basic needs of staying warm, breathing, and growing. With the use of NG/OG tubes, milk is slowly dripped down the tube where it goes directly into the stomach. Feedings are started slowly and residuals (the amount of milk left in the stomach after a feeding) will be checked to make sure the baby is digesting the milk correctly. An increase in stomach secretions, inability to digest the milk between feeds, and bloating are all indications that the baby’s bowels are not quite yet ready for food. As enteral feedings are tolerated, they will be advanced and parental feedings will be decreased until the baby is on full feeds; receiving their nutrition strictly from milk.
As your baby grows and is able to take feeding by mouth or breast, you will have the opportunity to practice this developmental milestone with your baby. Prepare yourself for a slow progression as it can be very demanding on the preemie. Think of these learning sessions as endurance training. Learning to feed either by breast or bottle is a matter of patience, persistence, and repetition. As your baby grows stronger, so will the feeding sessions, until your baby can take all feedings by mouth. Pacifier use has been shown to help develop the sucking reflex and strengthen the muscles necessary for oral feeding.
Mothers of premature babies produce milk that is higher in nutrients that help their baby grow, thrive and survive. The NICU can be a place that you feel out of control and unable to be a parent to your baby. Providing your preemie with breast milk is one of the very best things you can do for your baby. You don’t have to commit long term. As in the NICU, we often take it day by day. You can too. Every day you can provide the milk is another day you can watch as your baby grows and thrives based on the nutrition you and only you can give, and there is great power and satisfaction in that!