Breastfeeding premature babies
Breastfeeding is one of the most important activities for a mother, especially if the baby is born prematurely. Premature babies will need more nutrition than normal-weight babies born. His small body weight makes the mother more extra in taking care of it, including when giving breastmilk. That’s why breastfeeding for premature babies is an important phase to do.
breast milk is the best food for newborns, both mature born babies (normal) and less-mature infants (premature). The World Health Organization recommends exclusive breastfeeding during the first 6 months of baby’s life. However, parents of babies born prematurely often find difficulties in breastfeeding. Premature babies having a low birth weight may also be accompanied by medical disorders due to the immaturity of the function of some of their organs. Even sometimes they need intensive care so they are separated from their mothers for a while. These obstacles mentioned above have the role in giving breastmilk to premature babies. Want to know more about this topic. Keep reading.
What is a premature baby?
Premature babies are babies born at a gestational age of fewer than 37 weeks. Here are the categories of premature babies and their weight.
- Low birth weight babies with weight ≤ 2500 grams.
- Very low birth weight babies with weight 1000 ≤ 1500 grams
- Very low birth weight babies with weight ≤1000 grams.
Regarding the birth weight and gestational age, there are several specific things to be noticed before drinking breastmilk on premature babies. This is related to the maturity of the development of oral motor function.
The oral motor skills of premature babies are divided into 4 phases, they are:
- Growing reflexes.
- Maturity of respiratory function.
- Maturity of the swallowing process.
- Coordinating movements to suck, swallow, and breathe.
The sucking reflex component has begun to use since 28 weeks gestation, but it is still not in an optimal condition. Later, the baby is easily fatigued. A more regular mechanism will be obtained at 32-36 weeks’ gestation. Various studies state the strong relationship between infant maturity and the organized pattern of suckling proving the transition period can be accelerated by early suckling exposure.
Some common medical problems of premature babies may be found are the unstable general state of the baby, babies’ difficulty undergoing a transition period when sleeping to wake up or vice versa, stopping breathing, and low endurance. As a result, premature babies are at risk of experiencing malnutrition. This is caused by the increased growth rates and high metabolic needs, but inadequate reserves, a not complete physiological system of the body, or because the baby is sick.
Benefits of breast milk for premature babies
- Breast milk contains antibodies, anti-inflammatory, and other beneficial cells that help babies increase their immunity by themselves since premature babies generally have lower immunity and are more having the risk of infection compared to mature babies.
- Breast milk is very easy to digest compared to formula milk, the natural substances can protect the baby’s intestines.
- Breast milk supports brain growth and infant bone density. Breast milk can help the growth of the brain and body of premature babies, and better bone density.
Sometimes mothers are advised to give babies formula milk, but unsupervised administration can increase the risk of asthma, Necrotising Enterocolitis (fatal digestive disorders that attack the baby’s intestine), allergies, SIDS (sudden death syndrome in infants), heart disease, even meningitis.
The composition of breast milk obtained from mothers of premature infants
Breast milk from mothers who give birth to premature babies may be different from breast milk from mothers who give birth to a normal gestation baby. Breast milk is a type of body fluid, this composition is constantly changing to fulfill the nutritional needs of the baby. Breast milk in premature babies contains more cysteine, taurine, lipase which increases absorption of fat, long-chain polyunsaturated fatty acids, nucleotides and gangliosides, as well as having greater bioavailability for certain types of mineral elements.
The nutritional substance of breast milk for premature babies is higher than for mature babies, so the growth of premature babies is often good at first. The composition of breastmilk premature babies will change to the equal as the milk of a mature baby within 3-4 weeks. For premature aged 4 weeks babies, besides breast milk, human milk fortifier (breastmilk fortification) is also needed. Breastmilk fortification is formula milk containing bovine whey-predominant protein or hydrolyzate, a carbohydrate which consists mainly of glucose/maltodextrin polymers, containing sodium, calcium, phosphorus, magnesium, several micronutrients, and vitamins. From the Cochrane Reviews, it was found that multicomponent breastmilk fortification increased nitrogen retention, improved growth, and bone mineral substance. Fortification begins if the limitation to drink > 100 ml/kg/ day or the baby has reached full drinking. For optimal nutrition, premature babies need a nutrition intake of 180 ml/kg/ day. Giving Human milk fortifier or fortified breast milk is generally stopped when the baby is starting to care at home. Providing breastmilk fortification only if absolutely needed.
Giving breastmilk to healthy premature babies
The ability to suckle depends on the maturity of the suction and swallow reflex function in the baby. Babies with a gestational age of more than 34 weeks with a bodyweight of more than 1800 grams, can be breastfed directly by the mother because the suction reflex and swallowing are usually good enough. While babies who are 32-34 weeks of gestation with a birth weight of 1500-1800 grams, often has a good enough swallowing reflex. On the other hand, the sucking reflex is still not good. Mothers can give breast milk directly, also the milk can be given using a spoon, cup or dropper.
If the baby is born with a gestational age of less than or equal 32 weeks with a birth weight between 1250-1500 grams, the baby does not have good suction and swallow reflex, then the milk can be given by using a gastric/orogastric (sonde) pipe.
Provision of drinking using a cup is an alternative method of giving premature babies a drink. Giving breast milk using a cup or bottle, is associated with a high incidence of choking. But it’s still quite safe. Giving breastmilk with a cup requires a longer time with a smaller volume of drinking compared to a bottle, but the benefits obtained are that the baby can make arrangements for drinking needs, which are following the baby’s neurological development so that it does not cause compulsion when drinking.
In fact, many of the very low birth weight (VLBW) cannot suckle directly on the mother’s breast after birth and require the giving of drinking through orogastric pipes. There is no certainty about the best time for the baby to suckle directly to the mother. Experts suggest that low birth weight should not suckle directly because it is feared that too heavy workload for the baby since the suction reflex is only mature at 34 weeks.
Giving ASI to sick premature babies
Premature babies are often accompanied by health problems. Premature babies with severe illness may not be able to drink (enteral nutrition) so they need to be given nutrition through infusion (parenteral nutrition). Babies born with birth weight less than or equal 1250 grams with medical problems, may need to receive parenteral nutrition for the first 24-48 hours, then given trophic feeding (minimum breastfeeding) 10 ml/kg weight / 24 hours. If the baby has received it, then the amount of drinking can be increased while decreasing parenteral nutrition.
Since premature babies often cannot coordinate between sucking, swallowing and breathing movements, an orogastric tube is needed. The method often used is continuous and intermittent milk given every 3 hours. Recent research suggests that bolus-giving nutrition improves the concentration of hormones associated with drinking conditions, thereby improving gastrointestinal development, and obtains better drinking intake and growth in infants receiving bolus enteral nutrition. Bolus drinking is more beneficial than the provision of continuous drinking in premature infants with a relatively healthier gastrointestinal tract.
Giving breastmilk has the most noticeable effect because it is associated with decreased morbidity. Recommendations for drinking in infants born with a gestational age of fewer than 37 weeks must be based on birth weight and developmental stage.
Assess the adequacy of breastfeeding in premature babies
Weighting test is often used to estimate the intake of milk from breastfed infants. Milk samples were collected, then the baby was weighed without using clothes before and after getting breastmilk.
The increase in weight after the baby gets breast milk is calculated as the amount of breastmilk intake (grams). The measurement of the weight is converted into the volume size, multiplied by the specific gravity factor (which is 1.031). Baby weight is expected to increase by around 20-40 g /day if an increase above 40 g /day needs to be reconsidered, the possibility of excessive nutrition, or due to fluid retention.