Breastfeeding and Preemies – What Mothers Should Know

While it is well documented that breastfeeding is the healthiest option for babies, the benefits ring true in an especially critical way for premature infants.

While some expectant mothers know ahead of time that they may deliver prematurely, many others have no indication. In the midst of National Prematurity Awareness Month all mothers can arm themselves with some basic knowledge about the importance of mothers’ milk should they deliver prematurely.

Critical Importance for Preemies

Acting as a medicine for premature babies, mothers’ milk is more than just a source of food and nutrition - it offers protection in fighting the complications of prematurity through three main functions:

• The antibodies in mothers’ milk paint the inside of the baby’s intestines sealing off tiny open parts so germs cannot enter and make their way to the bloodstream.

• Some components of mothers’ milk directly kill germs while other parts make it difficult for them to grow.

• Mothers’ milk helps a premature baby develop the ability to fight infections on his or her own, by turning on certain genes and processes that control the immune system’s defenses against infection.

Getting Your Milk Supply Started

Colostrum, the milk a mother produces right after delivery, has the highest concentration of the antibodies necessary to fight complications of prematurity. Due to its high concentration of protective substances, colostrum is often referred to as “liquid gold”. Pre-term mothers make colostrum for a longer time period than do full-term mothers, and it is important to capture all of this ‘liquid gold’. There is a critical window shortly after delivery where preemies are more susceptible to illnesses. As a result it is recommended that mothers get off to an early start pumping, usually six hours after delivery. Mothers should pump roughly eight times a day to start, as often as if they were breastfeeding a full-term infant. Mothers can also take care to monitor their milk volumes by keeping a pumping log that tracks the frequency of pumping and the volume of milk pumped in a 24-hour period.

Bonding With Your Baby in the NICU

Mothers must realize that while they may not be able to directly breastfeed their infant while in the NICU, pumping provides a way to establish a relationship with their baby. By providing milk, mothers create an emotional connection through actively becoming engaged in caring for their baby. Mothers can use a breast pump at the baby’s bedside in the NICU where they can see and touch their baby. In addition, if a premature baby is healthy enough to be held, mothers can hold them in ‘Kangaroo Care’ (skin-to-skin), which helps boost the baby’s body functions including breathing, heart rate, oxygen levels, temperature and deep-sleep.

Remember Yourself

Finally, it is critical for mothers to take care of themselves and recognize that caring for a preemie is hard work.

www.justmommies.com
By Irene Zoppi

Breastfeeding a Premature Baby

Breastfeeding, although it may be more challenging with a preemie, is one great thing you can do to help your little guy or gal get off to the best start. Breastfeeding provides the perfect nutrition for a premature infant because your breast milk automatically adapts to your baby’s needs; something formula just can’t do. This is so important for a premature baby because your breast milk not only provides just the right amount of calories, fatty acids, vitamins, and protein for your premature baby, but it also helps your baby in other ways. Your breast milk is perfectly suited for your baby. It is more easily digested than formula which is particularly important for preemies as their digestive systems are not as mature as full term babies. Scientists have yet to figure out how to replicate all the ingredients that are found in breast milk. Breast milk contains nutritive components as well as components that help fight infection. In fact, about 80% of the cells in breast milk are macrophages. Macrophages are cells that help fight off viruses and infections. Because preemies face a higher risk of infection, feeding your baby breast milk is even more important. By breastfeeding your premature baby, you will help protect her delicate and immature immune system and give her the best nutrition possible.

Before you start breastfeeding

If your baby arrives early you may not be able to breastfeed her right away. Premature babies are often fed through a nasogastric tube to start off with, especially if your baby is born before 33 weeks. Babies do not develop the suck-swallow-breathe reflex that is needed for breastfeeding until they are about 32-33 weeks gestation. To help your baby get ready to breastfeed there are some things you can do. You should talk to your hospital caregivers to help you and your baby prepare for breastfeeding.

Get lots of skin to skin contact with your baby. Many hospitals encourage “kangaroo care” for premature babies. Before your baby can start kangaroo care, she needs to be stable enough that she can breathe on her own, or have minimal breathing support, and she also needs to be able to maintain a normal heart rate, oxygen level, and body temperature while she is being held. Kangaroo care is a type of skin to skin contact that gives moms and preemies a way to bond. It also helps preemies prepare for breastfeeding and has provides other health benefits for preemies.

Pump breast milk for your baby. Your preemie probably won’t be able to breastfeed right away, but you can still provide her the best nutrition by pumping breast milk for her. Pumping is very important when you have a preemie because your baby will not be sucking at the breast and stimulating your body to produce milk. The first few weeks after a baby is born are critical for establishing a good milk supply. If your baby isn’t nursing at the breast you will need to stimulate your breasts to produce milk by pumping. Your hospital will probably provide you a hospital grade pump while you are in the hospital, but after that you may need to rent a hospital grade pump. You can also purchase a double electric pump like Medela’s Pump in Style; however, a hospital grade pump is preferable when pumping for a preemie.

Pumping for a Preemie

Keep everything you pump, no matter how small the amount. When you first start pumping for your preemie you may only produce very small amounts of a yellowish substance called colostrum. It may seem like a minute amount and you may even wonder if it is enough to bother saving. Colostrum is very important for your preemie because it is very rich in carbohydrates, protein and protective antibodies. You should keep whatever you pump even if it just a few drops. Your baby will not eat very much during his first feedings so every little bit you can pump is important and should be kept.

Pump frequently. Since your preemie is so little, you may find it very easy to pump enough milk to meet his needs. Because of this, you may be tempted to pump less frequently. You should pump about every three to four hours, even if you are producing more milk than your baby is taking at the hospital. You can always freeze the extra milk to save for later. Plan to pump every three hours for about 10-15 minutes using a double electric pump. At night you can go a little longer between pumping sessions, but you should not go longer than five hours without pumping. Ideally, your pumping routine should mimic your baby’s eating routine so that once your baby starts nursing at the breast, your body is already in a similar routine as your baby. It is important to pump frequently because pumping frequently helps establish a good milk supply. Preemies often have a weaker suck and may not nurse as efficiently as full term babies. Pumping will help you to develop a good milk supply and hopefully once your baby gets stronger she will be able to nurse well enough to maintain this supply.

Drink plenty of water. Drink a large glass of water about an hour before you plan to sit down to pump. You may also want to keep a glass of water nearby while you are pumping because pumping can sometimes make you thirsty.

Massage your breasts before you pump. Massaging your breasts may help you to pump more. Try massaging your breasts before you pump. You can also try massaging your breasts after you have pumped for a while and notice that you are no longer pumping any milk. Watch for when your breasts stop producing milk. When you notice this take a break from pumping for a few minutes, massage your breasts and pump again. By using this technique, you may be able to pump as much as an ounce of extra milk or more for your baby.

Storing pumped milk

When you pump your breast milk, you should store it in small bags or containers. You can purchase special storage bags to keep your breast milk in. Ask your hospital caregivers how much you should store per bag and if it is okay for you to bring in frozen breast milk. Some hospitals do not allow the use frozen breast milk. Label your breast milk with your baby’s name and what date the milk was collected. The hospital will use the milk in order of when it is dated.

Breastfeeding your preemie

Once your baby is strong enough to breastfeed, your hospital caregivers will help you get started. Your baby may start out by just licking at your breast. She may suck at the breast for a while before she actually starts to swallow any milk. Preemies take a lot longer than full term babies to nurse. It may take her as long as 40 minutes to an hour for just one feeding. If she refuses to suck or keeps falling asleep, you should stop nursing and try again later. If you find the process is frustrating, you may want to work with a lactation consultant to help you. Your preemie may not suck well enough to empty your breasts when she nurses. For this reason, it is a good idea to pump after she nurses to make sure that your breast is emptied. Preemies may only nurse on one breast per feeding. This is not uncommon or something to worry about. To keep your supply up, you may want to pump the other breast after your baby nurses.

Breastfed preemies may need a supplement

Your doctor may advise you to give your baby a special supplement. Supplements can be added to your breast milk. You can even give your baby a supplement while you breastfeed by using a special tube feeding devise that allows your baby to nurse and take the supplement at the same time. This may seem discouraging to a breastfeeding mom, but supplementing will help your baby to thrive. Once your baby gains weight and starts breastfeeding better, you can work with your doctor on weaning from the supplement.

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Premature babies

Premature babies in the Czech Republic


In the Czech Republic about 8000 babies are born prematurely each year. The number of premature babies is rising. The current system, iniated in the 1990s, is not sufficient to provide adequate care for them, and this threatens the quality of care, which will inevitably decline, said the President of Czech Neonatology Professor Richard Plavka. For the past eight years, according to statistics, the number of premature newborns with low birthweight increased by 64 percent in the Czech Republic (CR)

In the CR there are currently 12 specialized centres of post-partum care. "The treatment is extremely effective," said Plavka. According to him, however, there is missing approximately one hundred specialised care beds, which cost 150 million crowns, because of technical equipment such as incubators. There is also lacking funding for high-quality staff, the current situation is extremely overloading those staff who stayed within the branch of neonatology.

While in 2008, 8638 children were born with low birth weight (under 2.5 kilograms), in 2000 there were 5277 children. Hospitalisation with very low birth weight (below 1.5 kg) takes several months. Lump sum payments do not take into account the increased cost of care, while the cost per volume of care provided cost 738 million koruna extra, estimated Plavka.
CR has one of the best systems of care for premature babies in the world, as measured for example by neonatal mortality, "said MEP Milan Cabrnoch, who worked as a paediatrician and for nine years in the development of newborns.

Neonatal mortality in the nineties was significantly reduced in Europe, even in the Czech Republic. Infant mortality is much lower when the baby is born in a specialized center. According to experts, it is necessary to improve the follow-up care for premature babies.

Especially children with very low birth weight (below 1.5 kg) .With extremely low birth weight (under kilogram) babies may have motor-neurone disorders, or behavioral problems with speech. They also tend to be hyperactive or have problems with emotional and social development and thus lagging behind in school, "said psychologist Daniel Sobotkova.

Parents of pre-term infants experience stress and fear for the child's health. They tend to have higher costs on commuting to rehabilitation. It is therefore important as financial support for parents, says Lenka Novotna of the civic association Nedoklubko, to support parents of children born earlier.