Breastfeeding a Preemie? Top Tips from a Lactation Consultant!

A birth is considered premature if a baby is born before the completion of the pregnancy, specifically before 37 weeks of gestation. There are three degrees of prematurity identified based on gestational age: moderate prematurity (between 32 and 36 weeks, roughly 7 to 8 months of pregnancy), severe prematurity (between 28 and 32 weeks, about 6 to 7 months), and extreme prematurity (before 28 weeks, less than 6 months). Given their unique nutritional needs, health authorities have long recommended prioritizing breast milk. “The benefits of feeding with mother’s milk are indeed even more significant for premature babies, especially those born before 32 weeks,” emphasizes Carole Hervé. But what happens when breastfeeding is challenging to establish? Here’s what you need to know.

Why Is It Important to Breastfeed a Premature Baby?

Breast milk significantly reduces complications seen in premature infants. As such, it’s regarded as an essential medicine for the breastfed baby, so much so that if the mother cannot or chooses not to breastfeed, it is preferable to feed the baby with donor milk. This is because breast milk contains valuable nutrients such as DHA, an essential fatty acid important for brain development, and immunoglobulin G, an antibody. It also contains enzymes that aid in digestion and help mature the baby’s digestive system. Breast milk is also rich in nutrients that protect the infant from infections. Additionally, studies have shown that premature babies fed breast milk are half as likely to be rehospitalized within the following year. In such cases, a milk bank will provide milk if the mother does not have enough.

Challenges in Breastfeeding a Premature Baby, What to Do?

Mothers of premature babies might feel helpless because they delivered earlier than expected. “To encourage lactation and establish breastfeeding, it is advisable to place the baby at the breast within the first hour after birth. If the baby latches on easily, great, otherwise, feed them colostrum with a small spoon. This is feasible when the baby is born full-term and healthy. In the case of a vulnerable or premature baby, it is suggested that the mother express her colostrum within the hour after her baby’s birth,” explains Carole Hervé. Within 48 hours or less, provide the mother with a hospital-grade automatic breast pump. By stimulating the breasts every 2 hours from day 2, optimal lactation is achieved, and the mother can continue breastfeeding if she wishes. However, if the baby is extremely premature, they will initially be fed via a tube with enriched breast milk, hence the importance of pumping milk.

How to Breastfeed a Premature Baby?

Here are some tips from Carole Hervé to facilitate the initiation of breastfeeding in a premature baby:

• Begin expressing breast milk as soon as possible after birth.
• Position the baby in kangaroo care: place them skin-to-skin against the mother’s body, keeping the airways clear.
• Encourage frequent breastfeeding and non-nutritive sucking, which are all learning opportunities, even when the child is exclusively fed by a nasogastric tube.
• Gradually transition the baby to bottle feeding to meet their nutritional needs.
• Use a slow-flow nipple to prevent the baby from being overwhelmed by the milk.
• Start by offering small amounts of milk (a few milliliters) frequently (8 to 12 times per day) rather than larger amounts less often.
• Pump for 10 to 20 minutes, followed by a breast massage for 1 to 2 minutes on each breast to collect a few more milliliters.
• Remember, using a breast pump should not be painful. If it is, seek advice from a qualified individual (IBCLC lactation consultant, specialized rental service).
• Gradually increase the amount of milk offered to the baby as their feeding capacity increases.
• Rely on the “milk flower” to visualize the increasing skills of the premature baby.
• Once the baby begins to breastfeed, continue to pump after each feeding to maintain high milk production.
• Upon discharge from the hospital and with steady weight gain, continue expressing with a breast pump at least three times a day, until the baby becomes truly effective at breastfeeding and their weight gain is regular and optimal.

How Much Milk Does a Premature Baby Drink? What Quantities?

A premature baby has a tiny stomach. Therefore, it is recommended to give small amounts of milk regularly. The needs of a premature baby are very subtle. To assess the amount of milk the baby starts to feed directly from the breast, 24-hour weighing tests are performed. The amounts of breast milk vary according to the weeks of gestation. Carole Hervé provides some guidelines:

• 24-28 weeks of gestation: 80-120ml/kg/day
• 29-32 weeks: 120-150 ml/kg/day
• 33-36 weeks: 150-180 ml/kg/day

The doctor will adjust these amounts on a case-by-case basis.

What Is the Best Breastfeeding Position for a Premature Baby?

The breastfeeding position depends on the age of the premature baby. Medical staff are trained to assist new mothers in finding the ideal position.

What Infant Formula Is Best for a Premature Baby?

While breast milk is the optimal food for a premature baby, for mothers who cannot or choose not to breastfeed, there are infant formulas specially designed for their needs. Most infant formula brands offer formulas tailored to the specific needs of premature babies. It is best to consult a pediatrician or pharmacist to find the most suitable option. Some examples include:

• Pre-GALLIA by Gallia Laboratories,
• Guigoz Expert Pre by Guigoz Laboratories,
• Modilac Expert Prema by Modilac Laboratories.

How Long Should Formula Be Used for a Premature Baby?

The baby should be fed infant formula for premature babies until they reach a satisfactory weight, starting from 2.8 kg. From this point, they can be fed a standard first-age infant formula up to the age of 6 months.