Here’s Why Your Premature Baby Needs Care and Lactation Support

According to WHO, every year about 15 million babies around the world are born prematurely (before 37 weeks of pregnancy). Mother’s milk is the only source that can provide optimal nutrition for the baby, especially at this stage. In cases of mother-infant separation such as in the neonatal intensive care units (NICU), breastfeeding may become a challenge.

Therefore, at this stage it is important for the mothers to follow a routine and keep certain things in mind while taking care of their preemie along with good support system to help them in their journey.

Available Lactational Support for Mothers & Key Criteria

Here are the list of available lactation support for mothers and some of the key criteria.

Antenatal Education

All expectant mothers/couples should be educated about breastfeeding during pregnancy. Research has shown that 2nd trimester is the best time for antenatal education as the mother is receptive to information. In case, there is impeding premature labour/birth, breastfeeding should be an important aspect of counselling.

Informed Decision

Standardised information for NICU mothers must be provided by the support team (doctors and nurses at the NICU) about the value of mother's milk specifying techniques to build an adequate milk supply. Providing consistent and timely information to NICU families not only helps them feel included in their baby's care but also enables them to make an informed decision and understand options available.

First Expression of Milk Post Delivery

Hospital protocols should outline expression within 1 hour of birth; regular trainings of the NICU staff and audits of performance must be carried out. Stimulating the breasts in the first hours via expression is important. This supports timely initiation and long-term milk production.

Frequent Expression of Milk

Hospital protocols must also outline expressing 8 or more times per 24 hours, including in the night; regular monitoring must still be performed. Frequent expression is critical to achieving adequate volumes. Double pumping every two to three hours is beneficial for this. Mothers should be taught and made to practice both manual and pump expression.

Time to Milk ‘Coming In’

Daily milk volumes must be tracked; mothers with delayed secretory activation (milk ‘coming in’) should be identified. Three consecutive expression volumes of more than 20 ml are an indicator of milk ‘coming in’. Delayed secretory activation, defined as more than 72 hours, has been associated with a shortened lactation and is a sign that increased lactation support is needed.

Volume of Milk

Mother’s expression details should be assessed regularly. Three consecutive days of more 500 ml total volume by day 7 are an indicator of successfully coming to volume. The average daily intake of exclusively breastfed infants aged 1–6 month is 798 ml per day (range 478–1356 ml). Most preemies would need very little milk in the initial days. This crucial time should be utilized to build on the mother's supply and all the excess milk should be stored for later use.

Managing Emotions

Breastfeeding is a very emotional journey for a mother and more so when her baby is born early. As we know, emotional stress has a direct impact on breast milk production, so it is important that the mother takes care of her Nutrition and hydration and ensures she gets proper rest. Thinking positive and lovingly about the baby, seeing a picture/video of the baby, smelling on baby's clothes or holding/seeing the baby while pumping can stimulate the milk supply and help express more milk.

Taking Care of Your Preemie’s

• Oral Therapy with Colostrum: Oral therapy should be regularly performed as a care practice until oral feeds begin. Regularly applying small amounts of mother’s colostrum to the infant’s lips and mouth can boost oral health in babies.
• Skin-to-skin Touch or Kangaroo Care and Breastfeeding: Kangaroo care is a practice of holding your baby to the chest (father) or breast (for mother) has numerous health benefits for the baby as well as the mother. Skin-to-skin and breastfeeding (when the infant is medically stable) helps transition to full breastfeeding and improves milk volume as well.
• Dose of Mother’s Milk: The frequency, duration and volume of milk must be regularly monitored. It is important to optimise the daily dose of Mothers milk from days 0–14 and days 0–28 as it is critical for providing maximum protection to the infant. Increasing doses of breastfeeding can help in decreasing risk of illnesses like NEC and sepsis in your baby.
• Breastfeeding Rates: When it's time for the mother to step out of the NICU, generally post 1, 3 or 6 months, it is important to measure the breastfeeding rates and measure NICU lactation outcomes so that she can easily breastfeed her baby whenever possible without any complication.

Caring for and learning to breastfeed a sick and premature baby can only be achieved only through continues support, practice and perseverance. It can be emotionally taxing for any new mother at this stage. Partner and other family members must understand that breastfeeding has enormous advantages for the preemie including protection against infection, better developmental outcome, and reduced stress. The emotional and support of loved ones as well as the healthcare team goes a long way in helping mothers achieve their breastfeeding goals.

(Dr Geetika Gangwani (PT), IBCLC (International Board Certified Lactation Consultant), Member of Medela India LC Club.)