By Laura Silvas, RN IBCLC

According to the World Health Organization, an estimated 15 million babies are born preterm every year. If your baby was born before 37 weeks of age, they would fall into the "preterm" category. As an L&D nurse, I have witnessed 35-week babies come out thriving with no issue. On the other hand, some 37-week babies come out and need extra assistance or have trouble transitioning from utero to the outside world.

Extreme preterm infants, born under 28 weeks gestation, are always transferred to the NICU (Neonatal Intensive Care Unit) after birth, as they are not developmentally mature enough to survive without extra assistance.

How does having a preterm baby impact my breastfeeding journey?

While things may not be as you pictured them to be after the delivery of your preterm infant, breastmilk is now even more critical to their development. Often, the baby is admitted to NICU or even a step-down unit. Concerns about getting enough calories, having a weak or shallow latch, suck/swallow coordination issues, and proper weight gain are major concerns for the new parents. Preterm infants may be harder to stimulate at the breast, leading to shorter, more frequent feeds and leaving breasts full.

Others may be unable to latch their baby until they have received approval from the NICU team, leaving pumping as the only option. Two major concerns with preterm infants are jaundice, necrotizing enterocolitis, and proper weight gain. Most moms are familiar with jaundice, as it is common in infants, despite their gestational age. Necrotizing enterocolitis (NEC) is an intestinal disease that occurs commonly in preterm infants when their small or large intestines become inflamed, injured, and risk perforation, leading to further complications. Studies show that breast milk, either from the infant's mother or DHM (donor human milk), prevents this complication. Breast milk is naturally easier for the small infant to process because it is a natural laxative, increases the infant's immunity, and increases the infant's good gut bacteria.

Why is breastfeeding beneficial for your preterm baby?

If you are allowed to latch your baby following delivery, and the option is available to continue doing so, take advantage! Frequent breast stimulation, colostrum delivery, and skin-to-skin contact will benefit your baby. Getting a wide latch may seem tricky with a preterm baby and such a small mouth. Try to over-exaggerate your nipple, and aim it for your baby's nose to encourage them to latch up and over the nipple to facilitate a proper latch. If there is pain, discomfort, pinching, etc., ask for assistance from the nursing staff or lactation team, if available. For the most part, NICU staff will include a lactation consultant.

If your baby is tiny, they may have limited sucking capabilities. Talk to your NICU team about "practicing sucking" between feeds. Your preterm baby may tire easily and have shorter, more frequent feedings. The goal is to feed your baby a minimum of eight times in a 24-hour period; however, your baby may tire at the breast and need to feed a little more often. Cue-based feedings or feeding on demand are usually stage-appropriate for a preterm baby. For example, the rooting reflex doesn't develop until around the 32-week mark.

The typical energy needs of the preterm infant are 120 kcal/kg/day. This volume may fluctuate depending on the infant's weight loss, diagnosis, and other complications. Your child's doctor may suggest supplementing your breastmilk with a fortified hypercaloric formula after feeding or adding it to your pumped milk.

If your baby is latching, you may be able to also use the Supplemental Nursing System (SNS). This system consists of a thin tube that connects to a reservoir with extra breastmilk or formula. The tube is gently taped to the mother's breast, with the tube exiting at the nipple. As the baby suckles at the breast, the SNS system helps release more milk. The milk can be a fortified formula to help increase the calories required, or more of your breastmilk, depending on your baby's needs. Your baby may also have other means of obtaining nutrition depending on their birth weight, including Intravenous, Gastronomy tube (G-tube), bottle, or syringe. If your infant has a g-tube, they can be set up in many ways, including directly to the stomach, through their nose, or mouth. Other breast-friendly options that may help as you transition to breastfeeding are using a cup, spoon, or oral syringe. All of these alternatives are typically available in the hospital setting.

Is preterm breast milk different?

At the beginning of your breastfeeding journey, your breasts produce colostrum, "liquid gold" that may "leak" during pregnancy and which satisfies your baby in the early days. Then, a few days following birth, your milk "comes in" or starts transitioning to mature milk. So, will your milk be any different if you have a preterm baby? The answer is yes. As previously mentioned, breastmilk can help to combat NEC (Necrotizing enterocolitis). The specifics boil down to increased amounts of Epidermal Growth Factor (EGF) and high levels of lactoferrin, which coat the baby's intestines to prevent any damage while they are still immature. Higher protein levels and carbohydrates (lactose) also help the preterm infant reach critical growth and development.

Tips for feeding your preterm baby

As always, providing breastmilk for your infant will take dedication, and hard work, especially for NICU babies. Listed are some tips to help you with your journey:

• Ask the hospital for assistance with obtaining a medical-grade breast pump

• Ask for assistance with latching and pumping

• Make sure your flanges are properly sized

• Lubricate your flanges

• Look at pictures or videos of your baby while you pump

• Do skin-to-skin as often as allowed

• Ask to watch your baby feed on your breastmilk, if able, to see the reward for your hard work

• Pump with a sock or blanket covering the bottles of your pump, so you aren't stressing over the amount you are pumping - Take your baby's blanket with you to pump so you can smell their scent.

• Place a (dry) breastmilk pad at the strap of your bra, and leave it with your baby so that your scent stays with them

• Empty your breasts often, 8-12 times a day

• Write encouraging notes to yourself or your baby on your breastmilk bags

• Reach out to a Lactation Consultant, not only during your baby's hospitalization but also following discharge. 

Remember, our Leva team is always on standby and ready to help, and we applaud you, mama.