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How often to feed a preemie baby


A Guide to Premature Baby Feeding and Preemie Nutrition

A Guide to Premature Baby Feeding and Preemie Nutrition

When it comes to premature baby feeding, you may have questions. Whether you're breastfeeding or formula feeding, learn more about preemie baby nutrition and your baby's feeding schedule.

Premature baby feeding

  • Premature babies need to eat at least every three hours. Tiny babies have tiny tummies. This means they’ll have to eat a lot of small meals for them to gain weight.
  • Your baby will eat at their own pace. While they may be eating every three hours, the premature baby feeding process is often slow. You'll soon recognize their pattern of swallowing and breathing. Babies who eat slowly seem to take more milk at each feeding and may be satisfied and sleep longer between feedings.
  • Their mouths are often extra-sensitive. If your baby has spent their first few days with tubes and respirators in their mouth, they may assume that anything that goes into their mouth is painful, which could include a breast or a bottle.
  • Premature babies are slow to feed. Feeding them too fast by mouth may result in a feeding aversion or spitting up. They are also likely to have more digestive issues than a full-term baby, since their digestive system may not be as mature as a full-term baby's.

Try these premature baby feeding tips

  • Each baby is unique. Follow the advice of your baby's doctor.
  • Introduce your baby to a nipple. Even if they are still feeding by tube, this will help them adjust to bottle-feeding when they’re ready. You may need to try different nipples at first.
  • Stick to breast milk or one type of formula and nipple to help them adjust.
  • Keep a record of your baby's feedings.
  • Get growth charts, specially designed for premature babies, from your baby's doctor to help monitor their progress.
  • Keep your baby on a fairly regular schedule of awake and nap time, to help them eat better.
  • Make sure your baby is fully awake before feeding.
  • Don't force your baby to eat. If they’re not sucking as fast, sealing their lips or turning away, they may be full.
  • Feed them on demand, not a schedule. Studies have shown that premature babies grew at a faster pace when fed on demand.
  • When your baby is developmentally ready, slowly introduce solid foods while they are still on formula.
  • Enlist the help and support of family and friends, to give yourself a break.

Preemie Nutrition

Most premature babies have low birth weight.

If a baby is too premature to breastfeed, moms are encouraged to pump their milk, as breast milk is considered to be best for the baby. Sometimes, doctors will recommend using a breast milk fortifier, to help give your baby the extra protein, vitamins, calcium and other nutrients they need at this early stage.

If you can't pump or breastfeed, or choose not to, ask your baby’s doctor about the specially designed formulas available for premature or low birth weight babies.

Premature babies may have more digestive issues than full-term babies.

Chances are, your baby’s feeding skills haven't fully developed yet. This means they’ll likely be slow to feed, or they may feed too fast and spit up or develop a feeding aversion. But there are some things you can try to help:

  • Introduce your baby to a pacifier. This can help get them used to the feeling of bottle-feeding for when they’re ready to switch over from the tube.
  • Record their feedings, so you can keep track of spit ups and how much they’re keeping down.
  • Monitor your preemie’s progress with growth charts from the doctor.
  • Try to keep them on a sleep schedule.
  • Make sure they are fully awake before feeding
  • Be aware of indicators, so you know when your little one is full or tired.
  • Slowly introduce solids when they are developmentally ready.

Babies who are born premature often undergo developmental testing and programs.

If your baby weighs less than 3.5 lbs. at birth, they will most likely be referred for formal developmental testing around their 1st and 2nd birthdays. If your baby is born prematurely, your doctor may recommend an infant stimulation program. This usually involves working with a physical therapist or specialized healthcare professional to learn gentle exercises, positioning and other ways to interact with your premature baby and help them with physical development. Early intervention programs can help with social and functional skills and provide support for the family.

Preterm babies have a harder time maintaining the proper water balance in their bodies. These babies can become dehydrated or over-hydrated. This is especially true for very premature infants. Keep the following preemie nutrition facts in mind as you navigate feeding your baby:

  • Premature babies may experience more water loss through the skin or respiratory tract than babies born at full term.
  • The kidneys in premature babies have not grown enough to control water levels in the body.
  • The NICU team keeps track of how much premature babies urinate (by weighing their diapers) to make sure that their fluid intake and urine output are balanced.
  • Human milk from the baby's own mother is the best for babies born early and at very low birth weight.
  • Human milk can help babies avoid infections and sudden infant death syndrome (SIDS) as well as necrotizing enterocolitis (NEC).
  • Many NICUs will give donor milk from a milk bank to high-risk babies who are not able to get adequate amounts of milk from their own mother.
  • Special preemie formulas can also be used. These formulas have more added calcium and protein to meet the special growth needs of premature babies.
  • Older premature babies (34 to 36 weeks gestation) may be switched to regular formula or a transitional formula.
  • Babies who are given breast milk may need a supplement called human milk fortifier mixed into their feedings. This gives them extra protein, calories, iron, calcium, and vitamins. Babies fed formula may need to take supplements of certain nutrients, such as vitamins A, C, and D, and folic acid.
  • Some infants will need to continue taking nutritional supplements after they leave the hospital. For breastfeeding infants, this may mean a bottle or two of fortified breast milk per day as well as iron and vitamin D supplements. Some babies will need more supplementation than others. This may include babies who are not able to consume adequate amounts of milk through breastfeeding to get the calories they need to grow well.
  • After each feeding, babies should seem satisfied. They should have 8 to 10 feedings and at least 6 to 8 wet diapers each day. Watery or bloody stools or regular vomiting could indicate an issue and you should discuss them with your doctor.

Preemie Weight Gain

Weight gain is monitored closely for all babies. Research suggests developmental delays could be associated with premature babies who experience slow growth.

  • In the NICU, babies are weighed every day.
  • It is normal for babies to lose weight in the first few days of life. Most of this loss is water weight.
  • Most premature infants should start gaining weight within a few days of birth.
  • The desired weight gain depends on the baby's size and gestational age. Sicker babies may need to be given more calories to grow at the desired rate.
  • It might be as little as 5 grams a day for a tiny baby at 24 weeks, or 20 to 30 grams a day for a larger baby at 33 or more weeks.
  • In general, a baby should gain about a quarter of an ounce each day for every pound (about 1/2 kilogram) they weigh. (This is equal to 15 grams per kilogram per day. It is the average rate at which a fetus grows during the third trimester).

If you are experiencing difficulty affording specialty premature formulas for your baby, financial assistance is available.

Enfamil has developed a program called Helping Hand for Special Kids, to help families who need specialty formulas for their premature baby but have difficulty affording them. Depending on your needs, the Helping Hand program provides either long-term assistance or a free, one-time shipment of products. To us, all babies deserve the very best start in life. Ask your doctor if you qualify for this program.

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Breastfeeding your premature baby - NHS

Your breast milk is important to your baby at any age. Giving your premature baby your breast milk benefits their health as well as yours.

Breast milk:

  • helps protect your baby from infections, particularly of their gut – premature babies are more likely to get infections
  • contains hormones, nutrients and growth factors that help your baby to grow and develop
  • is easier for your baby to digest than formula milk, because it's human milk specially designed by your body for your baby

See other benefits of breastfeeding.

If your baby is very small or sick, they may not be able to breastfeed from your breast at first. But you can start regularly collecting your breast milk (called expressing) as soon as possible after your baby is born.

This will help get your milk supply going and the milk you express can be frozen so you can give it to your baby later. Then you can start breastfeeding from the breast once you and your baby are ready.

Even if you were not planning to breastfeed, you could express your breast milk for a while to help boost your baby's immune system in the early weeks after birth.

Spending lots of time close together with your baby can help boost your breast milk supply and establish breastfeeding.

Skin-to-skin contact with your premature baby

If your baby is well enough, you'll usually be encouraged to spend time holding them against your skin as soon as possible. This is sometimes called kangaroo care.

Your baby will usually be dressed just in a nappy, hat and socks and then placed inside your top, under a blanket, or in a soft sling so they can be held securely against your skin. If it's cold outside, you can also put them in a sleeveless vest with an open neck.

This skin-to-skin contact helps you feel close to your baby. Your partner can enjoy this kind of contact as well.

For your premature baby, skin-to-skin contact:

  • reduces stress and pain
  • promotes healthy weight gain
  • helps to establish breastfeeding
  • helps them sleep better
  • helps to regulate and support their heart rate and breathing

For mums, skin-to-skin contact:

  • helps reduce your chance of developing postnatal depression
  • increases your confidence as a new parent
  • can help make breastfeeding easier and increase the amount of milk you make

For dads and partners, holding your baby skin to skin:

  • helps you bond with your baby – babies can hear both parents' voices in the womb and will be calmed by the sound of your voice as well as their mum's
  • helps you feel more confident as a parent

Expressing milk if your baby is premature

It's recommended you express often, ideally at least 8 times a day to begin with – including at least once at night – to keep your milk supply up.

In the early days, it's often easier to express your milk by hand. Your midwife or a breastfeeding supporter can show you how.

You'll probably only express a few drops to begin with but, if you hand express often, this will increase. Even if you are only expressing a small amount it will still help your baby.

In the early days you can collect your breast milk in a small, sterile cup and store it in a syringe.

Once you are producing more milk, you could try using a breast pump. If your baby is in a neonatal unit, the hospital will usually be able to lend you an electric breast pump for expressing your milk. If they cannot lend you one, you can hire one.

Read more about breastfeeding help and support to find out about hiring a pump, or phone the National Breastfeeding Helpline on 0300 100 0212.

The staff, your midwife or a breastfeeding supporter can give you advice about how to increase your milk supply. They can also show you how to encourage your milk to flow and how to use a breast pump.

Always ask for help early if you have any worries or questions.

Tube feeding your baby

Babies do not normally learn to co-ordinate the sucking, swallowing and breathing needed for feeding until about 34 to 36 weeks of pregnancy.

If your baby is born before this time, they may need to have breast milk through a feeding tube to begin with. This goes through their nose or mouth into their stomach. The staff in the neonatal unit can show you how to feed your baby this way.

Babies who are very premature or sick may need to be fed through an intravenous (IV) line to begin with. A fluid containing nutrients is fed straight into your baby's vein.

The Bliss website has more information and advice about tube feeding

Using donor breast milk

Some hospitals can provide donated breast milk for your baby to have until your own supply is established.

See the United Kingdom Association for Milk Banking (UKAMB) website for more information about donor breast milk

If donor breast milk is not available, your baby can have formula milk until you're producing enough breast milk.

It's recommended you do not buy donor milk over the internet. This is because the source cannot be confirmed and you cannot be sure whether the donor or the milk has been screened for infections.

Moving on to breastfeeding your premature baby

While holding your baby, you may notice them try to move towards your breast. Gradually, as they develop and get stronger, they will be able to breastfeed directly.

The first time you try it, the hospital staff may ask you to express first, then put your baby to your breast. This is so your baby is not overwhelmed when your milk lets down.

At first, your baby may only lick the breast, then next time take a few sucks until they gradually become happy and confident feeders.

You can combine tube feeding with breastfeeding until your baby is getting everything they need from the breast only.

Using a lactation aid (supplementer)

You could also consider using a lactation aid. This is a way of supplementing your baby's breastfeeds with either expressed breast milk or formula.

A tiny tube is taped next to your nipple so your baby can get milk through the tube as well as from your breast while attached to your breast. This helps to support your baby as they get used to attaching to the breast.

Got a breastfeeding question?

Sign into Facebook, or use an Amazon Alexa or Google Home and use the Start4Life Breastfeeding Friend chatbot for fast, friendly, trusted NHS advice anytime, day or night.

Breastfeeding a premature baby at home

Until now, your baby has been cared for in the neonatal intensive care unit. You have started breastfeeding. You are now ready to fully transition to breastfeeding at home. This information will help answer some of your questions about such care.

Preparing for your child's discharge

  • Express more milk than necessary. This stimulates the production of the maximum possible amount of milk. The more milk produced, the easier it is to feed the baby. nine0003

  • Find out your baby's weight at discharge from the neonatal intensive care unit. This will help you keep track of whether your baby is gaining weight at home.

Breastfeeding at home

  • Continue to use the positions recommended for premature babies until the baby weighs at least 2. 5 kg (5-6 lbs). (Some more of these are listed below.) nine0003

  • Try to feed your baby 8-12 times a day. You may be advised to feed your baby when he is hungry rather than on a schedule. This will make the child less tired. But in some cases, scheduled feeding is necessary to ensure that the baby is getting enough food. If you think that the child is hungry, you should feed him between the scheduled meals.

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  • Before moving on to the second breast, the baby should receive the maximum amount of milk from the first. This is important because hindmilk (the last milk that comes out of the breast) contains more fat and calories than milk that comes out first.

  • Many doctors recommend expressing milk in addition to feeding your baby until your baby is exclusively breastfed and is growing and developing well without the need for additional formula or nutrition. This will help increase or maintain breast milk production. nine0003

  • If you have been prescribed nutritional supplements for your child, talk to your doctor about the best way to give them.

How do you know if a child is getting enough food?

Your pediatrician should determine your child's milk intake shortly after discharge. This can be done either during the appointment or over the phone. To make sure your child is getting enough food:

  • Count the number of wet and soiled diapers. Must have 8 wet diapers a day and at least 1 bowel movement.

  • During feeding, listen to see if the baby is swallowing milk. If you don't hear this, your baby may suckle at the breast but receive little or no milk.

  • nine0002 After feeding, the breast should be soft and empty. The child should look happy.

  • The child is weighed at every visit to the pediatrician. You can also weigh your baby using a baby scale at home.

  • If you have problems breastfeeding, contact a lactation consultant. Find a local organization that supports breastfeeding mothers. Organizations like these can be an excellent resource for help on basic issues. This can be especially helpful if you are breastfeeding more than 1 baby! nine0003

Should I expect problems with breastfeeding due to preterm birth?

Breastfeeding a premature baby can be difficult at first. As the child begins to grow stronger, everything will be normal. These issues may include:

  • Difficulties with correct placement of the nipple in the mouth

    • nine0007

    Falling asleep at the breast at the start of feeding

  • Problems coordinating sucking, swallowing and breathing

  • Poor suckling (difficulty getting enough milk even with prolonged feeding)

  • Unpredictable sleep pattern

Breastfeeding positions

Premature babies should be fed in positions that provide extra support for the neck and head. These are the safest feeding positions for preterm babies:

Lying on the back

Sit in a reclining chair with your body bent at a 45° angle. In this position, a good place for your baby to fidget on their tummy is your chest. In this case, the entire body of the child is supported. The baby reflexively moves to the nipple, finds it and begins to suck. This is the most comfortable position for both of you. Your hand is free as the child is held by your body. nine0003

Football position

Place a pillow next to you on the side of the breast you are going to feed your baby. Place your baby on a pillow at chest level. Support the baby's head with the palm of your hand. Use your forearm to support your child's shoulders and back. The child's legs should pass between your arm and the body. If you are breastfeeding twins (twins), this position will allow you to breastfeed both babies at the same time.

Cradle position

Place a pillow on your knees and place the baby on it at chest level. Support the baby's head and neck with the arm opposite the breast you will be feeding. Support the baby's head by the back of the head below the level of the ears. Support your chest with your other hand.

© 2000-2022 The StayWell Company, LLC. All rights reserved. This information is not intended as a substitute for professional medical care. Always follow your healthcare professional's instructions. nine0003

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Feeding premature babies | Breastfeeding premature babies

Premature babies have a special need for breast milk, but it can be difficult to breastfeed them directly. Our expert advice will help you provide your premature baby with healthy breast milk. nine0003

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Professor Katsumi Mizuno, Department of Paediatrics, Showa University Koto Toyosu Hospital:
Katsumi is a Certified Breastfeeding Consultant, Professor of Pediatrics at Showa Medical University, and one of Japan's leading pediatric neonatologists. His research focuses on neonatal suckling skills, breast milk banking, and the use of breast milk for feeding premature babies in neonatal intensive care units. nine0003

Babies born before the 37th week of pregnancy are considered premature. 1 The causes of preterm birth are not always obvious, but certain factors increase the likelihood of such an event. These include: twin or multiple pregnancy, certain diseases of the mother or fetus, as well as a history of premature birth.

Because premature babies spend less time in the womb, they are not mature enough and may be more susceptible to infection and disease. They often require hospitalization in the neonatal intensive care unit. nine0003

Why is breast milk important for premature babies?

Breast milk is essential for optimal growth and development of term babies, but it is even more important for premature babies.

During pregnancy, the fetus receives important substances from the mother through the placenta, such as DHA (a fatty acid essential for brain and eye development) and immunoglobulin G (an antibody). 2.3 A premature infant did not receive all of these substances. However, the milk produced by a premature mother contains more fat and secretory immunoglobulin than mothers of full-term babies. nine0152 4

In addition, premature babies have an underdeveloped gastrointestinal tract, which can make digestion and absorption of nutrients difficult, so they need food that their sensitive stomach and intestines can easily digest. Breast milk contains enzymes that facilitate the digestion of the baby, 5 as well as epidermal growth factor, which accelerates the development of the gastrointestinal tract 6 . Premature infants who are predominantly breastfed have much lower intestinal permeability than formula-fed infants, meaning fewer potentially harmful particles from the stomach and intestines enter their bloodstream. nine0152 7

Breast milk is so important for premature babies that if the baby's mother does not produce enough breast milk at first for any reason, it is recommended to make up for the shortage with donor milk rather than formula.

Does breast milk improve the condition of premature babies?

Breast milk contains protective substances that can prevent serious illnesses that preterm infants are susceptible to, 8 e.g. severe infections, 9 retinopathy of prematurity (which can cause vision loss) 10 and bronchopulmonary dysplasia (chronic lung disease). 11

The more milk your baby gets, the lower the risk of disease. 12 Every additional 10 ml of milk per kilogram of body weight per day reduces the risk of developing sepsis by 19%. 9 The risk of developing necrotizing enterocolitis (a potentially fatal bowel disease) in preterm infants who are breastfed is ten times lower than those who are formula fed. nine0152 13 That's why every drop counts!

Most importantly, premature infants who are breastfed are typically discharged an average of two weeks earlier than formula-fed infants. 14 They also have a 6% lower risk of readmission in the first year of life. 15

Breast milk has been proven to have a beneficial effect on mental and physical development in the long term. Studies show that low-birth-weight babies who are breastfed in the neonatal intensive care unit have an average IQ of up to five points higher than those who are not breastfed. nine0152 15 In addition, their cardiovascular system works better during their lifetime. 17

Will milk be produced if the baby is born prematurely?

Yes, the mother's body is ready to produce milk already by the middle of pregnancy. After the baby is born and the placenta is born, the level of progesterone, the pregnancy hormone, drops, and the production of colostrum, the first milk, starts in the breast. This usually happens after the newborn is put to the breast and begins to suckle rhythmically, but if the baby was born prematurely, he most likely will not be able to latch on at first. nine0003

To replicate the sensations that trigger milk production, you can manually stimulate the breasts and nipples, or use a breast pump to express nutrient-rich colostrum for your baby. 18 Read below for more information on what to do if your premature baby is not yet able to breastfeed.

Breast milk usually comes in two to four days after birth, but if it was premature, the milk supply may be delayed. However, a recent study shows that moms who started pumping within one hour of giving birth had milk coming in as expected. nine0152 19 This is why it is important to start expressing breast milk as early as possible.

How to prepare if the baby is expected prematurely?

Visit the neonatal intensive care unit to see how it works and how premature babies are cared for. In addition, it will be useful to learn how breast milk is produced and secreted and why it is not only a healthy food, but also an important medicine for premature babies. Read more about this in our free e-book Surprising Breast Milk Facts .

What if a premature baby cannot breastfeed?

Many babies born before 34 weeks have difficulty coordinating sucking, swallowing and breathing. Until the baby masters these skills, nurses will feed him through a tube that is inserted into the nose or mouth and provides food directly into the stomach. In this way, the baby can be fed continuously until he is ready to breastfeed.

If your baby is too weak to latch on and suckle milk, you can use a breast pump* available at the hospital or maternity hospital to “do the job for the baby”. Breast stimulation with research-based technology, 20 mimics the rhythm of a baby's suckling, plays an important role in starting and maintaining milk production in the first hours after birth 21 .

Milk should be expressed at the same frequency as term infants are usually fed every two to three hours, i.e. 8 to 12 times a day.

You can try putting a small amount of expressed breast milk into the baby's mouth with a syringe, or putting milk-soaked cotton swabs in the baby's mouth. 22 This way your baby will recognize the taste of your milk, which will facilitate the transition to breastfeeding in the future. In addition, the protective substances that make up breast milk will help strengthen the local immunity of the baby's oral cavity. You can be involved in the care of your premature baby in a variety of ways - check with your healthcare provider for details.

Very low birth weight babies - less than 1.5 kg - usually need extra protein, calcium and phosphorus, so they are given fortified breast milk. In some countries, such additives are made on human milk, and, for example, in Japan, on cow's milk. nine0003

Recommendations for pumping milk

If the baby will be in the neonatal intensive care unit for a long time, neonatologists recommend using a double breast pump for pumping. I always recommend Medela Symphony*. Double pumping not only speeds up the process, but also produces an average of 18% more milk than pumping from each breast in turn. 23

In addition, I advise you to create the most comfortable conditions for pumping. It is generally agreed that it is best to express milk during or after prolonged skin-to-skin contact with the baby (more on this "kangaroo method" below). Another good option is to sit next to the crib and watch your baby while he pumps. Oxytocin (the hormone that stimulates milk flow) is released when you look at your baby, touch him, smell him and think about him, 24 Therefore, comfortable and calm conditions must be created for this in the neonatal intensive care unit.

What is kangaroo care for premature babies?

The so-called kangaroo method involves prolonged skin-to-skin contact between parents and infant. This is extremely beneficial for you and your baby, as well as for milk production. Skin-to-skin contact normalizes the baby's breathing and heartbeat, keeps him warm and allows him to be as close to the parent as possible. Kangaroo care is believed to have a beneficial effect on the health of premature babies, 25 and it helps mothers express more milk 26 and breastfeed longer. 27 Skin-to-skin contact 30-60 minutes before feeding gives baby time to wake up and be hungry so he can eat without being forced.

What if the neonatal intensive care unit offers formula feeding?

Feel free to state that you want to breastfeed your baby instead of formula. If you don't have enough breast milk to feed your baby, ask the ward for help to increase your milk supply. nine0003

It is natural for mothers whose babies are in the neonatal intensive care unit to experience anxiety and stress. Sometimes these experiences interfere with milk production, so it's important to ask for any help you may need. Remember that you have the right to seek support. Your healthcare provider may be able to recommend a suitable lactation specialist, such as a lactation consultant, for you.

How to switch from pumping to breastfeeding? nine0005

At whatever stage of pregnancy a baby is born, if the baby is stable enough for skin-to-skin contact, it can seek the breast itself for sedative suckling. This is the perfect way for your baby to learn sucking skills before they learn to coordinate sucking, swallowing and breathing.

Babies love the smell of breastmilk, so you can put some milk on the nipple before putting your baby to the breast to make him want to suckle. He might even be able to suck some milk. Don't worry if your baby seems to suck very little - he learns every time. He can start with one or two sips and gradually move on to full breastfeeding. Until then, the baby can be fed through a tube, pressed to the breast, so that the taste of milk and touching the breast is associated with a feeling of satiety. nine0003

You can put your baby to the breast for sedative suckling as soon as you are ready for kangaroo care, unless your baby is suffering from bradycardia (slow heartbeat) or low oxygen levels in the blood. You can switch to breastfeeding as soon as the baby is ready for it. Gradually, he will gain enough strength to suckle longer and suck out more milk.

Literature

1 World Health Organization. Geneva, Switzerland; 2018. Media Centre: Preterm birth fact sheet; November 2017 [03/26/2018]. Available from : http://www.who.int/mediacentre/factsheets/fs363/en/ - World Health Organization. Geneva, Switzerland; 2018. "Media Center: Prematurity Fact Sheet"; November 2017 [3/26/2018]. Article at: http://www.who.int/mediacentre/factsheets/fs363/en/

2 Duttaroy AK. Transport of fatty acids across the human placenta: a review. nine0225 Prog Lipid Res . 2009;48(1):52-61. - Duttaroy A.K., "Transfer of fatty acids across the human placenta: a review". Prog Lipid Res. 2009;48(1):52-61.

3 Palmeira P et al. IgG placental transfer in healthy and pathological pregnancies. Clin Dev Immunol. 2012;2012: 985646. - Palmeira P. et al., Placental transfer of immunoglobulin

5 Pamblanco M et al. Bile salt - stimulated lipase activity in human colostrum from mothers of infants of different gestational age and birthweight. Acta Paediatr. 1987;76(2):328-331. - Pamblanco M. et al., "Bile salt-activated lipase and its activity in colostrum of mothers of infants of various gestational ages and birth weights." Akta Pediatr. 1987;76(2):328-331.

6 Dvorak B. Milk epidermal growth factor and gut protection. J Pediatr. 2010;156(2): S 31-35. - Dvorak B., "Epidermal growth factor in milk and gut protection". F Pediatrician (Journal of Pediatrics). 2010;156(2):S31-35.

7 Taylor SN et al. Intestinal permeability in preterm infants by feeding type: mother's milk versus formula. Breastfeed Med . 2009;4(1):11-15.- Theilon S.N. et al., "Intestinal permeability in preterm infants and its association with type of feeding: breast milk or formula." Brestfeed Med (Breastfeeding Medicine). 2009;4(1):11-15.

8 Newburg DS. Innate immunity and human milk. J Nutr . 2005;135(5):1308-1312. — Newburgh, D.S., "Natural Immunity and Breast Milk." F Nut. 2005;135(5):1308-1312. nine0225

9 Patel AL et al. Impact of early human milk on sepsis and health-care costs in very low birth weight infants. J Perinatol . 2013;33(7):514-519.- Patel A.L. et al., "Impact of early breast milk on sepsis and health care costs in extremely low birth weight infants". Zh Perinatol (Journal of Perinatology). 2013;33(7):514-519.

10 Zhou J et al . Human milk feeding as a protective factor for retinopathy of prematurity: a meta-analysis. Pediatrics. 2015;136(6): e 1576-1586. - Zhou Q. et al., "Breastfeeding as a protective factor against retinopathy of prematurity: a meta-analysis. " Pediatrix (Pediatrics). 2015;136(6):e1576-1586.

11 Patel AL et al. Influence of own mother's milk on bronchopulmonary dysplasia and costs. Arch DIS Child FETAL NeONAT 4 4. 2017;102(3): F 256- F 261. - Patel A.L. et al., "Effect of breast milk on bronchopulmonary dysplasia and health care costs." Arch Dis Child Fetal Neonate Ed. 2017;102(3): F 256- F 261.

12 Meier PP et al . Improving the use of human milk during and after the NICU stay. Clin Perinatol. 2010;37(1):217-245. - Meyer P.P. et al., "Optimizing the use of breast milk during and after a stay in the neonatal intensive care unit. " nine0225 Perinatol wedge. (Clinical perinatology). 2010;37(1):217-245.

13 Lucas A, Cole TJ. Breast milk and neonatal necrotising enterocolitis. Lancet. 1990;336(8730-8731):1519-1523. — Lucas A, Cole TJ, "Breast milk and neonatal necrotizing enterocolitis." Lancet 1990;336(8730-8731):1519-1523.

14 Schanler RJ et al. Randomized trial of donor human milk versus preterm formula as substitutes for mothers' own milk in the feeding of extremely premature infants. nine0225 Pediatrics. 2005;116(2):400-406. - Chanler R.J. et al., "Randomized Trial of Donor Human Milk Versus Prematurity Formula as a Breast Milk Substitute in Severely Preterm Infants". Pediatrix (Pediatrics). 2005;116(2):400-406.

15 Vohr BR et al. Beneficial effects of breast milk in the neonatal intensive care unit on the developmental outcome of extremely low birth weight infants at 18 months of age. nine0225 Pediatrics. 2006;118(1): e 115-123. - Thief B.R. et al., Developmental Beneficial Effects of Breast Milk in the Intensive Care Unit on Extremely Low Birth Weight Infants by 18 Months of Age. Pediatrix (Pediatrics). 2006;118(1):e115-123.

16 Victora CG et al. Breastfeeding in the 21st century: epidemiology, mechanisms, and lifelong effect. Lancet. nine0225 2016;387(10017):475-490. - Victor S.J. et al., "Breastfeeding in the 21st century: epidemiology, mechanisms and long-term effects". Lancet (Lancet). 2016;387(10017):475-490.

17 Lewandowski AJ et al. Breast milk consumption in preterm neonates and cardiac shape in adulthood. Pediatrics. 2016;138(1): pii : e 20160050. - Lewandowski, A.J. et al., "Breastfeeding in preterm infants and cardiovascular health in adulthood." nine0225 Pediatrix (Pediatrics). 2016;138(1):pii:e20160050.

18 Meier PP et al. Which breast pump for which mother: an evidence-based approach to individualizing breast pump technology. J. Perinatol. 2016;36(7):493-499. - Meyer P.P. et al., Breastpump Selection: A Scientific Approach to Customizing Pumping Technology. Zh Perinatol (Journal of Perinatology). 2016;36(7):493-499.

19 Parker LA et al. Effect of early breast milk expression on milk volume and timing of lactogenesis stage II among mothers of very low birth weight infants: a pilot study. J Perinatol. 2012;32(3):205-209. - Parker L.A. et al., "Effect of early pumping on milk supply and timing of the second stage of lactogenesis in mothers of extremely low birth weight infants: a pilot study." Zh Perinatol (Journal of Perinatology). 2012;32(3):205-209.

20 Meier PP et al. Breast pump suction patterns that mimic the human infant during breastfeeding: greater milk output in less time spent pumping for breast pump-dependent mothers with premature infants. J Perinatol. 2012;32(2):103-110. - Meyer P.P. et al., "Pumping patterns that mimic breastfeeding behavior: more milk and less time for constantly pumping mothers of preterm infants." nine0225 J Perinatol (Journal of Perinatology). 2012;32(2):103-110.

21 Parker LA et al. Association of timing of initiation of breastmilk expression on milk volume and timing of lactogenesis stage II among mothers of very low-birth-weight infants. Breastfeed Med . 2015;10(2):84-91. - Parker L.A. et al., "Effect of early pumping on milk supply and timing of the second stage of lactogenesis in mothers of extremely low birth weight infants: a pilot study." nine0225 Brestfeed Med (Breastfeeding Medicine). 2015;10(2):84-91.

22 Lee J et al. Oropharyngeal colostrum administration in extremely premature infants: an RCT. Pediatrics. 2015;135(2): e 357-366. - Lee J. et al., "Oropharyngeal colostrum ingestion in very preterm infants: a randomized controlled clinical trial." Pediatrix (Pediatrics). 2015;135(2):e357-366. nine0225

23 Prime PK et al. Simultaneous breast expression in breastfeeding women is more efficacious than sequential breast expression. Breastfeed Med 2012; 7(6):442–447. - Prime D.K. and co-authors. "During the period of breastfeeding, simultaneous pumping of both breasts is more productive than sequential pumping." Brestfeed Med (Breastfeeding Medicine). 2012;7(6):442-447.

24 Uvn 9 ä s Moberg K Oxytocin effects in mothers and infants during breastfeeding. Infant 2013; 9(6):201–206. - Uvenas-Moberg K, Prime DK, "Oxytocin effects on mother and child during breastfeeding". Infant. 2013;9(6):201-206.

25 Boundy EO et al. nine0225 Kangaroo mother care and neonatal outcomes: a meta-analysis. Pediatrics. 2015;137(1): e 20152238. - Boundi I.O. and co-authors, "The Kangaroo Method and Its Impact on Newborns: A Meta-Analysis". Pediatrix (Pediatrics). 2015;137(1): e20152238.

26 Acuña-Muga J et al. Volume of milk obtained in relation to location and circumstances of expression in mothers of very low birth weight infants. nine0225 J Hum Lact . 2014;30(1):41-46 - Akunya-Muga, J. et al., "The amount of milk expressed by location and circumstances of pumping in mothers of extremely low birth weight infants." F Hum Lakt. 2014;30(1):41-46

27 Nyqvist KH et al. Towards universal kangaroo mother care: recommendations and report from the first European conference and seventh international workshop on kangaroo mother care.

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