How to breastfeed a premature baby?

We speak of prematurity when the birth takes place before the end of the pregnancy, i.e. before the 37th week of amenorrhea (SA). There are three levels of prematurity, depending on gestational age: average prematurity (between 32 and 36 WA – 7 to 8 months of pregnancy), severe prematurity (between 28 and 32 WA – 6 to 7 months of pregnancy), and very prematurity (before 28 weeks – less than 6 months of pregnancy). The nutritional needs of premature babies are so specific that in recent years, health authorities have recommended that they be fed breast milk. “The advantages of feeding with mother’s milk are indeed even more important for premature babies than for children born at term, all the more so for those born at less than 32 weeks.“, says Carole Hervé. But, what to do when the establishment of breastfeeding turns out to be complicated? Answers.

Why is it important to breastfeed a premature baby?

Breast milk can very significantly reduce the complications observed in premature infants. As such, it is considered a real medicine for the breastfed baby, so much so that if the young mother does not wish or is unable to breastfeed, it will be preferable to feed him milk from a donor. And for good reason, breast milk contains valuable nutrients such as DHA, a fatty acid essential for proper brain development, and immunoglobulin G, an antibody. It also contains enzymes that promote baby’s digestion and contribute to the maturation of his digestive system. Breast milk is also rich in nutrients to protect the infant against infections.

Difficulties breastfeeding premature baby, what to do?

Moms of a premature baby may feel helpless because they gave birth earlier than expected. “To promote lactation and the establishment of breastfeeding, it is recommended to put baby to the breast within the first hour after delivery. If he takes it easy, so much the better, otherwise we give him colostrum by the teaspoon. This is possible when the baby is full term and healthy. In the specific situation of the vulnerable or premature baby, it is suggested that the mother collect her colostrum within an hour of the birth of her baby“, develops Carole Hervé.

From 48 hours or less, we will provide the mother with a automatic breast pump hospital grade. By stimulating the breasts every 2 hours on D2, we obtain optimal lactation and the young mother can continue breastfeeding if she wishes. On the other hand, if the baby is extremely preterm, he will be fed through a tube of enriched breast milk at first, hence the interest of expressing milk.

Here are some tips from Carole Hervé for promote the establishment of breastfeeding in a premature baby:

• Start expressing breast milk as soon as possible after birth.
• Position the baby as a kangaroo : place him skin to skin against his mother’s body, with the airways clear.
• Encourage frequent breastfeeding and non-nutritive sucking all of which are learning opportunities, even when the child is exclusively fed by nasogastric tube.
• Gradually bring the baby to bottle drink to meet their nutritional needs.
• Use a slow flow teat to prevent the baby from being overwhelmed with milk.
• Start by offering small amounts of milk (a few milliliters) frequently (8-12 times a day) rather than larger amounts less often.
• Express the milk for 10 to 20 minutes, and follow with a breast massage for 1 to 2 minutes on each breast to collect a few more milliliters.
• Remember that using the breast pump should not be painful. If this is the case, seek advice from a competent person (IBCLC lactation consultant, specialist hire company).
• Slowly increase the amount of milk offered to the baby as his feeding capacity increases.
• Rely on the “milk flower” to visualize the growing skills of the premature baby.
• From the moment the baby begins to suckle at the breast, continue to express milk after each feed to maintain high milk production.
• On leaving the maternity ward and with constant weight gain, continue expressing with the breast pump at least three times a day, until the baby becomes really effective at the breast and his weight gain is regular and optimal.

How many mL does a premature baby drink? What quantities?

A premature baby has a very small stomach. It is therefore recommended that he give small amounts of milk regularly, knowing that the request of the premature baby is very subtle. In order to assess the amount drunk by the baby who begins to feed directly from the breast, we carry out weighing tests over 24 hours. The quantities of breast milk vary according to the weeks of amenorrhea. Carole Hervé gives us some pointers:

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

The doctor will decide to adjust these quantities on a case-by-case basis.

Which breastfeeding position for a premature baby?

The breastfeeding position depends on the age of the premature baby. The medical staff is trained to help young mothers find the ideal position.

Which infant milk for a premature baby?

Breastmilk is still the best food for a premature baby, but for moms who can’t or don’t want to breastfeed, there are infant formula adapted to their needs. Most of infant milk brands offer formulas dedicated to the specific needs of premature babies. It is best to seek advice from the pediatrician or pharmacist to find out which is the most suitable. Let us mention in particular:

• Pre-GALLIA from Gallia laboratories,
• Guigoz Expert Pré milk from Guigoz laboratories
• Modilac prema expert from Modilac laboratories.

Until which month should prema baby milk be used?

The baby should be fed infant formula for premature babies until he has reached a satisfactory weight, i.e. from 2.8 kg. From then on, it can be fed with a standard first age infant formula up to 6 months of age.

Thanks to Carole Herve, IBCLC lactation consultant, author of ” My tailor-made breastfeeding ” (ed. Albin Michel) and “Choose to breastfeed” (ed. First

Isabelle Petit, pediatric nurse and Catherine Grattepanche, pediatrician, IBCLC, neonatology department of CH 59300 Valencienne, France, La fleur de Lait, Nyqvist KH, Rubertsson C, Ewald U, Sjödén PO Development of the Preterm Infant Breastfeeding Behavior Scale (PIBBS): a study of nurse-mother agreement. J Hum Lact Sep; 12(3):207-19.