Why Is Breast Milk Important For Premature Babies

Why Is Breast Milk Important For Premature Babies

Premature babies particularly benefit from breast milk. Although this is a challenging time for you as a mom, there is no denying that breast milk will provide the best nourishment. Breast milk’s compositions are tailored to meet the needs of your preemie baby. Here, I will explain how it will nourish and protect your baby and the different methods to how you can give this liquid gold to your baby.

Why is breast milk important for premature babies? Among the top health institutions including the World Health Organization and the American Academy of Pediatrics recognize the health benefits that only breast milk can offer to premature babies. The AAP suggests that no matter how you deliver it to your baby, breast milk still serves as the best source of nourishment possible. Specifically, these are the top reasons why breast milk is important and recommended for premature babies:

  • Contains more of the nutrients needed for a premature baby
  • It provides antibodies that help fight infection
  • It helps protect a premature baby’s gut
  • Improved digestion and absorption
  • Your baby excretes breast milk faster
  • Breastfeeding is less stressful for your baby than compared to bottle feeding

It also reduces the chance of acquiring:

  • Retinopathy of Prematurity (ROP)
  • Necrotizing Enterocolitis (NEC)

Increases the chances of:

  • Suboptimal Brain Development

I will talk about each aspect in more detail as well as answer some of the most common questions parents have with regards to giving breast milk or breastfeeding a premature baby.

Do preemies need breast milk?

According to the Centers for Disease Control (CDC), approximately 1 in 10 babies was born prematurely in the United States. Babies born earlier than 37 weeks are considered a “preemie.”

Preemies are much smaller and behave differently to full-term babies. Since they are born weeks earlier, they will miss some of the important aspects of physical development that happens during the latter part of pregnancy. Their organs aren’t fully developed yet and they will need some special care under the NICU or the Neonatal Intensive Care Unit, until such time that their body can fully function on its own.

In this very challenging time where you worry about your baby’s health and survival but feel like you can’t do anything to help him. You may be barely allowed to hold and be with your preemie, but there is one thing you can do to help- you can offer him your breast milk! Breast milk is the natural food for human babies. Even during pregnancy, your body makes milk that specifically matches your baby’s needs. During this critical time of his development, your preemie needs all the benefits breast milk has to offer.

Formulas can’t replicate is your body’s ability to produce milk which is specifically designed to meet the needs of your premature baby. If you’ve given birth a few weeks early, your breasts will produce colostrum, followed by premature milk.

Premature milk is slightly different in composition when compared to the milk of mothers who have delivered full-term infants. This breast milk will help your newborn premature baby adapt during his first few weeks. Premature breast milk has a higher protein and mineral content, which is needed for tissue and organ development. It also contains different types of fat that can easily be digested and helps in your baby’s brain and neurologic development.

A study was carried out by the AAP which examined the composition of premature breast milk. The results showed that premature milk contained significantly higher concentrations of protein, sodium, and chloride, and lower levels of lactose than milk from mothers who had delivered at full term. This shows that preterm breast milk is uniquely adapted for your baby. Below is a list of some of the most important reasons why breast milk is so important for your premature baby:

Why do premature babies need breast milk?

a premature baby's feet with the writing "why is breast milk important for premature babies"

As mentioned earlier, there are certain benefits that a premature baby can only get from breast milk. These are the reasons why even a small amount of breast milk can make a difference in his overall wellbeing.


Since your baby has a premature immune system, she is at a higher risk of developing infections such as sepsis, respiratory, gastrointestinal, and infections of the urinary tract. Feeding your baby breast milk allows you to pass on your immunity to your baby. This passive immunity will help your baby fight infections during the first few months of life.

This passive immunity comes in the form of antibodies (also known as immunoglobulins) present in your breast milk that formula milk can’t offer. During the final three months of pregnancy, a large proportion of these antibodies cross over from the placenta to the developing fetus. Due to your preterm baby’s age, she will not have received some of these antibodies. However, if she is breastfed, she will receive these antibodies through your breast milk. These are concentrated in the colostrum but are also present in mature milk. The longer you breastfeed your baby the longer she will receive these benefits.

Gastrointestinal Protection

Your premature baby’s gut is much more sensitive than that of a full term baby. The unique composition of breast milk makes digestion less stressful for his tiny tummy. There are certain cow’s milk proteins found in formula that may not be tolerated easily by your baby. Moreover, studies show that premature infants who are fed with breast milk have a reduced risk of developing intestinal infections when compared to formula-fed babies. Breast milk was found to offer extra protection against necrotizing enterocolitis (NEC). This is a condition where part of a baby’s bowel undergoes tissue death. NEC is one of the leading causes of death among premature infants.

Improved digestion and absorption

Breast milk is high in whey protein which is easily digested and absorbed. In addition, breast milk contains the enzyme lipase, which helps babies digest fat more effectively. These are the reasons why breast milk is readily digested and doesn’t stay too long in a baby’s tummy compared to formula.

Ease in excretion  

Since nutrients are more readily absorbed, waste products are also being excreted from your baby’s body more efficiently. This ease in excretion is equally important since it facilitates the passing of your baby’s first stool, meconium. Meconium is comprised of the waste products from when your baby was in the womb. Passing out stools during the first few days also helps prevent the build-up of the yellowish waste product called bilirubin. Raised bilirubin levels may cause neonatal jaundice. Neonatal jaundice is a serious condition that will require additional treatment and may be debilitating for a premature baby.

Breastfeeding is less stressful for your baby

According to La Leche League, breastfeeding is found to be less stressful for a preemie than bottle feeding. A premature baby will have more difficulty coordinating sucking and breathing with a bottle. These difficulties may be due to the fact that the flow of milk comes faster from a bottle that a premature baby is not able to keep up with.

Breastfeeding occurs in harmony with a relatively new concept known as “kangaroo care which can have a positive effect on the stress levels of your premature baby.” The mother will act as the primary caregiver. She will wear her baby in a special wrap for as long as is possible. Results have shown that there is an increased likelihood that your baby is more likely to breastfeed more easily while also assisting your body in producing more milk. Many other benefits of kangaroo care include stabilizing temperature, increasing her immune system and increasing oxygenation levels. Last but not least you will strengthen that important bond between you and your baby.

Unfortunately, each hospital differs in their policies of skin-to-skin care of preterm infants. Discuss with the staff in your hospital the possibilty of having more direct contact with your baby.

Breast Milk’s Role In Preventing Specific Illnesses and Conditions

Retinopathy of Prematurity (ROP)

Research has shown that giving breast milk to preterm babies can help prevent or reduce the complications of a host of conditions. These include:

This is a condition that can result in severe visual impairment or blindness. Abnormal vessels grow and spread throughout the retina of the eye. This leads to scarring of the retina due to the vessels fragility which causes them to leak fluid into this area. This research paper examined the impact of premature infants fed breast milk to those who were fed formula milk. The results showed that the breastfed babies were associated with a lower incidence of retinopathy of prematurity compared to those that were fed formula.

Brain Development

Studies have shown that preemie babies fed breast milk either in the form of their mothers own milk or donor milk had a more positive impact on their brain development. A study led by Professor Boardman of Edinburgh University in the UK concluded that babies who exclusively received breast milk for the last three-quarters of their days spent in hospital showed improved brain connectivity compared with others. This will have life long benefits as it involves important cognitive functioning such as learning ability and memory,

Necrotizing Enterocolitis (NEC)

This is where premature infants’ intestines are weak due to insufficient oxygen or blood flow. The intestines are unable to fight any bacteria that has entered the system therefore potentially causing localized tissue death. This can further lead to a serious systemic infection and possibly death. Multiple research has been carried out to identify the impact of breast milk taken by premature infants with this condition. These studies conclude that breast milk could be protective and therapeutic in neonates with NEC. It also mentions that babies who receive formula milk are at a higher risk of developing NEC compared to those who were breastfed.

In addition to a reduction in these conditions, it has also been shown that preterm babies fed breast milk have decreased rates of being rehospitalized after discharge. This can only have a positive effect on both baby and mom. It will be much less stressful for both to spend their time at home. Mom can care for her baby full time without the disruptions of a hospital routine and all that involves.

a premature baby with a nasogastric tube lying in an incubator
Premature newborn baby in the hospital incubator after c-section in 33 week

How much milk should a premature baby drink?

Right after delivery, you may notice that your breasts will only produce a small amount of thin milk. This is called colostrum. Your preemie will only need a small amount of milk during his first few days. Despite its small quantity, colostrum is concentrated with all the nutrients and immune-boosting antibodies that your baby needs during this time. Even right after your milk supply has increased, premature babies may only drink an ounce or less per feeding. Any amount of breast milk you can offer your baby will be of enormous benefit.

How much milk should I be pumping for a preemie?

During the first few days, you may be instructed to express your milk, collect it using a small sterile cup or spoon and stored in a syringe. Some mothers prefer hand expressing their first milk or colostrum. This would be preferable to using an electric or manual pump. Colostrum comes in such quantities that some would inevitably get lost within the tubing and container of the pump.

When your milk supply comes in, your hospital may provide you with a pump during your stay. You can also either rent or buy one for your own use at home.  I would advise you to choose a pump that mimics your baby suckling at the breast rather than just a sucking device. You will most likely be using a hospital grade pump which will have this function and is much more efficient in extracting milk. You may only collect a few drops to begin with but don’t worry! It will gradually increase soon as long as you keep expressing your milk.

According to the AAP, mothers should aim to pump 6 to 8 times a day at regular intervals, similar to how your baby usually feeds. This would mean that you should pump during nighttime too, and you should not sleep continuously for more than 4 to 5 hours at night. If you wake up with a feeling of fullness in your breasts, it could signify that you are sleeping too long. Long periods of time without pumping will have the effect of diminishing your milk supply. Keep pumping and store your milk in the freezer for your baby’s future consumption. Doing so will ensure that you will have maintained your milk supply until such time that your preemie is stable enough to latch on and feed directly from you breast. You will also provide them with your own breast milk in the meantime.

Babies usually develop their sucking, swallowing and breathing coordination between weeks 32 to 34 of pregnancy. If your preemie is born before this period, the milk you collected may be fed via a tube which goes directly to his stomach. Usually, tube feedings are handled by the hospital staff, especially when your baby is still at the NICU. The quantity of milk and frequency of feedings will depend on the health status of you baby and your doctor’s recommendations.

Important points to remember for pumping milk for your preemie:

  1. Use a double pump to effectively collect milk from both breasts at the least possible time.
  2. The minimum requirement for pumping throughout the 24 hour period is 100 minutes.
  3. Continue pumping even after your milk stops coming to stimulate an increase in milk supply.
  4. Gently massage your breasts using small circular motions from the edge of the breasts going towards the center before and during the use of a pump.
  5. If you notice that your milk fluctuates from time to time, increase the number of times you pump each day to ensure that you maintain a steady supply.

How can a preemie increase milk supply?

If you have a preemie, you might also be worried about how this situation will affect your milk supply. Establishing a good milk supply for a preemie is more challenging than if you have a full term baby who can actively suckle and feed from your breasts. However, with the right advise and support it can of course be done. There are a lot of mothers of premature babies who have managed to increase their milk supply and effectively breastfeed once their baby is physically stable and ready to participate in breastfeeding. If you’re wondering about what you can do right now, here are some ways to help maintain your milk supply:

Maximize skin-to-skin contact

Skin to skin contact is found to be beneficial not only for the growth of premature babies but also for establishing mom’s milk supply. Holding your baby skin to skin towards your chest whenever it is approved by your doctor is one way to stimulate the release of your lactating hormones. Oxytocin in particular, helps with your milk let-down.

Choose the right pump

When your baby is still small and unable to breastfeed efficiently, you will be required to pump your milk to establish your milk supply. In addition to the recommended frequency of pumping, it’s essential to ensure you are using the right pump which is appropriately sized for you. A breast pump that has the ability to mimic a baby’s natural rhythmic suction with a faster and more slower setting would be the most beneficial. Hand and battery operated pumps tend to be less effective.

Hand express your milk

Doing it manually is helpful especially during the first few days when you will only getting a small quantity of your first milk or colostrum. Gently massage your breasts in circular motions to stimulate a good flow of milk and unclog your milk ducts. You may also do this right before or while you are pumping. I have some helpful tips on hand expression in which after time and experience will become second nature to you.

Pump by your baby’s side

Some mothers find it helpful to pump at their baby’s bedside. Depending on their hospital policy, many will be happy to provide mothers a time to pump by their baby’s side at the NICU or while holding their baby during kangaroo care. The mere presence of your baby will activate your mothering hormones which will also help your body to produce more milk.

Increase your fluid intake

If you become dehydrated you will have difficulty producing more milk. Keep an active eye on your fluid intake. Have at least 8 glasses of water. Other fluids count too such as milk, tea or coffee in moderation and fruit juices. Cut back on liquids that may interfere with your milk production like those loaded with caffeine and alcoholic beverages.

Take some rest

You have just given birth and your body needs some time to heal and recover. Giving birth prematurely is indeed be a stressful time, particularly if there are concerns regarding your baby’s health. However, stress can interfere with your ability to produce breast milk for your baby. Try to take a deep breath, relax and get good quality sleep whenever it is possible. Talk with your partner or other family members regarding your concerns to establish a good support system.

Encourage baby to latch

Encouraging your preemie to latch might be a challenge at first, especially if your baby got used to feeding via tube or a bottle. Because of this, preemies are more likely to have nipple confusion or nipple preference. Once your baby is stable enough and approved by your doctor, hold your baby towards your nipples every time you establish skin to skin contact and allow enough time for him to nuzzle and suckle at the breast. This article specifically discusses reintroducing breastfeeding after exclusively pumping.

Breastfeed while baby is alert but calm

Preemies can get tired easily and this might be a reason for them to refuse the breast. The possibility of success in breastfeeding a preemie during the early days increases if you can time each breastfeeding session when he is awake, active and calm. Active sucking is vital for increasing your milk supply, so the more your baby can participate, the better.

Using at-breast supplementers

At-breast supplementers are devices which deliver your expressed breast milk via a bottle or a syringe that is attached close to your breasts and connected to a tube that is taped near your nipple. These devices can be helpful in encouraging your preemie to actively suck to increase your milk supply. At the same time, it will ensure that she will get enough milk through the supplementer. At breast supplementers can be used upon the recommendation of your doctor and with the assistance of a lactation consultant in your hospital.

Freeze breast milk for future use

frozen expressed breast milk in storage bags with a manual breast pump in the the middle

Any additional breast milk that you have not given your baby can be frozen for future use. If you have a preemie who is too ill to suckle from the breast, you can continue to maintain your milk supply up by pumping and freezing your breast milk for future use. Your baby will in time be able to consume all the breast milk you stored. In addition to this, you will have a good supply of milk to give to your baby. Here is a guide on how to prepare and store breast milk for freezing.

Just like any other baby, premature babies can greatly benefit from the goodness of their mother’s milk. Establishing a good milk supply and breastfeeding might be more challenging for a preemie, but what’s important is that you’ll be able to provide the best possible nutrition to your baby- your breast milk!

Related Questions

Do Premature Babies Develop Slower

Premature babies will develop according to their age corrected age. For example, if your baby was born at 32 weeks you need to allow 8 weeks to allow for her prematurity, as a full term baby will be born at 40 weeks. So when she is 12 weeks old, subtract 8 from 12 leaving her age corrected at 4 weeks. You would expect her to reach the milestones of a 4 week old baby. This age adjustment continues until the child is 2 years old.

When Can A Preemie Sleep Through The Night

The sleep pattern of a preemie baby is different from that of a term baby. The American Academy of Pediatrics state a term baby might sleep a full 6 to 8 hours at night by four months. However, a premature baby will most likely take longer and may not accomplish this task until 6 to 8 months or later.

Do Preemies Teeth Later

As with any milestones in your preemie baby’s development, you need to age-adjust according to her age. In full-term babies teething usually occurs at about 6 months to one year. There can be huge variations in teething but it will most likely occur after your preemie baby reaches 6 months.

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