Breast milk and your premature baby

This leaflet is for parents whose baby has been born prematurely (before 37 weeks gestation) or for parents whose baby may be born prematurely.

The importance of breast milk

Even if you don’t plan to breastfeed your baby, please read this leaflet to see if you would consider expressing breast milk for your baby while they are on the Neonatal intensive Care Unit (NICU). Your breast milk is very important for your premature baby as it helps to protect them from infection and gut problems.

Your baby may not be ready to breastfeed for some time, but they can still be given your expressed breast milk to help keep their mouth clean and moist (mouthcare). Your expressed breast milk can also be given through a feeding tube as soon as they are ready.

What are the benefits of breast milk for premature babies?

Protection from infection – your milk will help to boost your baby’s immune system. It is packed with antibodies and other substances that help your baby to fight infection. This is especially true of your first milk (colostrum). Babies who are born before 32 weeks gestation will be given probiotics to encourage colonisation of their guts with healthy bacteria, and breast milk also helps with this.

Healthy gut – premature babies are at risk of developing inflammation in their gut, a condition called necrotising enterocolitis (NEC). Some babies with NEC become very unwell. Although we don’t understand exactly what causes this condition, we know that babies who are fed with breast milk are less likely to suffer from NEC.

Growth – your milk is specially designed to meet the needs of your baby. It contains many nutrients including proteins, fats and other substances that your baby needs to grow. As your baby gets older, the team looking after them may suggest adding some some vitamin supplements and fortifier to your milk to boost the amount of nutrients your baby receives to help their growth.

Bonding – expressing your breast milk can be challenging, but it can also be very rewarding. It can help you to feel close to your baby and can support you in building a strong bond with your baby.

Long term benefits – in the longer term, breastfed babies are at less risk of cot death, obesity and allergies and are less likely to be re-admitted to hospital after they have been discharged. Breast milk helps premature babies with brain development as they grow up. Breastfeeding can also be more convenient and less expensive than formula feeding.

When can I start expressing my milk?

Your body will still be able to make breastmilk even if you give birth very early, but your breasts will need regular stimulation to start and maintain milk production. You can start expressing your milk soon after your baby is born. Evidence shows that if you can express within 1-2 hours after giving birth to your baby, your milk volumes will double over the first 7 days, compared to if you express for the first time more than 2 hours after giving birth and this difference continues for at least 4 weeks.

What if I cannot express my milk or if I can’t get enough milk?

When you begin to express milk you will only get a few drops of colostrum (your first milk) at a time. This is normal. It is important to continue expressing regularly (8-10 times every 24 hours, including once between midnight and 06:00) and to make sure you get enough rest and have plenty to eat and drink. It can help to stay close to your baby when you express, or to have a photo or a bonding square nearby. You can get help and support with expressing your milk from the midwives and neonatal nurses looking after you and your baby and you can be referred to the infant feeding team if more support might be helpful. Every drop of “liquid gold” breast milk helps your baby.

Some people will be unable to express breast milk for medical reasons. Your baby may also need some extra milk while your milk supply is increasing. In this case your baby may either receive a standard term formula or a specialist preterm formula, depending on how early they are, their weight and their clinical condition. Some babies who are born very early or with a very low birth weight may be given donor breast milk for a short period of time. The doctors and nurses looking after your baby will discuss the options that would be suitable for your baby with you in more detail.