How to breastfeed a premature baby? Advice from a lactation consultant

We speak of premature birth when a baby comes into the world before the end of the pregnancy, that is to say before 37 weeks of amenorrhea (SA). Three degrees of prematurity are distinguished according to gestational age: average prematurity (between 32 and 36 weeks, i.e. 7 to 8 months of pregnancy), extreme prematurity (between 28 and 32 weeks, i.e. 6 to 7 months), and very extreme prematurity (before 28 weeks, i.e. less than 6 months). The nutritional needs of these babies being specific, health authorities have been recommending breast milk for several years. “The advantages of feeding with mother’s milk are in fact even more important for premature babies than for full-term children, especially for those born at less than 32 weeks“, underlines Carole Hervé. But when breastfeeding is difficult to establish, how to react? Explanations.

Why is it important to breastfeed a premature baby?

Breast milk very significantly reduces the complications observed in premature children. As such, it is considered a real medicine for the breastfed baby, so much so that if the young mother does not want to or cannot breastfeed, it will be preferable to feed it with 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 that help protect the infant against infections.. Furthermore, several studies have shown that premature babies fed breast milk have half the risk of being rehospitalized in the following year. The medical team will then rely on a lactarium to provide milk to the baby if the mother does not have any, or not enough.

Difficulties breastfeeding premature baby, what to do?

Mothers 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 your baby to the breast within the first hour after delivery. If he takes it easily, so much the better, otherwise, we gives him colostrum with a teaspoon. This is possible when the baby is born full-term and healthy. In the specific situation of the vulnerable or premature baby, it is suggested that the mother collects 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 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 very premature, he will be fed through a tube with enriched breast milk initially, hence the interest in 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 in a kangaroo position : place him skin to skin against his mother’s body, with the airways open.
• 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 drink from a bottle to meet their nutritional needs.
• Use a slow flow teat to prevent the baby from being overwhelmed by milk.
• Start by offering small amounts of milk (a few milliliters) frequently (8 to 12 times per day) rather than larger amounts less often.
• Express milk for 10 to 20 minutes, and follow up 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 rental 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 breastfeed, continue to express milk after each feeding in order to maintain high milk production.
• Upon leaving the maternity ward and with constant weight gain, maintain breast pumping at least three times a day until the baby becomes truly 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 regularlyknowing 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, weighing tests are carried out over 24 hours. The quantities of breast milk vary depending on the weeks of amenorrhea. Carole Hervé gives us some pointers:

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

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

What breastfeeding position for a premature baby?

The breastfeeding position depends on the age of the premature baby. Medical staff are trained to help new mothers find the ideal position.

Which infant milk for a premature baby?

Breast milk remains the best food for a premature baby, but for mothers who cannot or do not wish to breastfeed, there are infant formula adapted to your needs. Most of infant milk brands offer formulas dedicated to the specific needs of premature babies. The best is to ask the pediatrician or pharmacist for advice to find out which one is most suitable. Let us cite in particular:

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

Until what month should we use prema baby milk?

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

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