By Dr Prashanth Gowda
According to the World Health Organisation (WHO), about 15 million babies are born pre-term and this number is increasing. Complications due to premature birth are one of the leading causes of death in children below five years of age. Breastfeeding can act as a shield to protect premature babies from these issues. Mother’s milk is extremely crucial. If the baby is premature and accepts the mum’s milk well, it helps in reducing NEC (gut gangrene), infection, quick recovery and helps in getting early discharge.
Why is it difficult to breastfeed premature babies?
Babies are considered to be pre-term if they are born before the 37th week of pregnancy. There are subcategories of preterm birth, based on gestational age:
- Extremely preterm (babies that are born in less than 28 weeks)
- Very preterm (born between 28 to 32 weeks)
- Moderate to late preterm (born between 32 to 37 weeks)
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Premature babies, especially the ones that are younger than 33 weeks, are not strong enough to gain nutrition by direct breastfeeding to gain weight. They cannot directly breastfeed effectively as they are not able to coordinate sucking, swallowing and breathing. They have immature and sluggish gut and systemic illness, poor attachment and sucking effort on the breast, poor swallowing, easy tiredness (and hence poor intake), vomiting, regurgitation or abdominal distension. Hence, mothers feeding a premature baby may need to extract breastmilk to feed the baby. The reflux of sucking, swallowing is well established by 34 weeks; those babies over this gestational age can attempt direct breastfeeding.
The things you need to know while breastfeeding a premature baby:
Mother’s emotional and psychological stability
Any premature delivery is never anticipated or predicted. Every mother and doctor would want the baby to grow until the expected gestation in the womb. This sudden preterm delivery will lead to emotional and psychological stress/instability of the mother, and it is very difficult for mother to accept the tiny baby. Good antenatal counselling and social support can solve this problem as breast milk production is directly linked to emotional and psychological aspects of the mother.
Expressing breast milk
As soon as the baby is born, it is important for a mother to start collecting breast milk by expressing it. It is advisable to express breast milk as early as possible, within an hour of the birth and then continue to express every 2-4 hours to keep the constant supply. All preemie mothers should be adequately trained for expressing milk, hygiene storage and good lactational counselling (tube feeds, pallada/katori feeds), direct breastfeeding if the baby is more than 34 weeks, burping following feeds.
Skin-to-skin care is different from kangaroo care. The WHO recommends skin-to-skin care immediately after delivery for every newborn, irrespective of the birth weight to ensure warmth and early initiation of breastfeeding in the delivery room.
Kangaroo Mother Care (KMC)
Kangaroo Mother Care is a cost-effective and impactful standardised care for low birth weight infants which, like breastfeeding, should be part of routine care. It can prevent up to half of all deaths in infants weighing less than 2000 g. KMC can reduce complications like mortality at discharge and at the latest follow-up, severe infection/sepsis, nosocomial infections, lower respiratory tract disease, hypothermia and length of hospital stay, improved weight, length and head circumference, increased breastfeeding rates, better mother-infant bonding and maternal satisfaction with the method of care, as compared with conventional methods. KMC satisfies all five senses of the infant. The infant feels the mother’s warmth through skin-to-skin contact (touch), listens to her voice and heartbeat (hearing), sucks breast milk (taste), has eye contact with her (vision) and smells her odour (olfaction).
Babies that are born before 32 weeks of pregnancy will have to be fed through a feeding tube. This tube goes through their nose or mouth to their stomach. The hospital staff will feed them this way initially and if required, they can teach the parents to feed the baby in this manner.
Feeding the milk from the breast
Once the premature baby is more than 34 weeks of gestational age, while holding the baby, we may notice them trying to move towards your breast. Gradually, as they develop and get stronger, they will be able to breast-feed directly. Mothers can combine tube feeding with breastfeeding until your baby is getting everything; they need from the breast only.
Frequent breast pumping is essential
A breast pump can be your best-friend if your baby is premature. You need to pump often to establish your milk supply. Mothers can combine hand expressing with pumping if that helps you increase your milk supply.
It’s recommended mothers express often, ideally at least eight times a day to begin with – including at least once at night – to keep the milk supply up. In the initial days, it is easier to express mother’s milk by hand. Midwife or a breastfeeding supporter can guide you with this. Mothers probably may only express a few drops to begin with, but if they express often, it will increase. Even if the mother is only expressing a small amount, it will still help your baby. Mothers can collect breast milk in a small, sterile cup and store it in a syringe. Once they begin to produce more milk, they can try using a breast pump. If your baby is in a neonatal unit, the hospital will usually be able to lend an electric breast pump for expressing milk.
With good antenatal support and care of the mother, preterm delivery can be prevented, and if it happens, prior information about preterm delivery, preparedness, good health facility and good social support can help any preemies. Irrespective of any gestation, it is important to feed mother’s milk for the extremely good outcome of the premature baby.
(Dr Gowda is the Head Consultant Paediatrician & Neonatologist, Motherhood Hospitals, Sarjapur, Bangalore)
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