How to feed premature babies at home

Today, prematurity is not a critical diagnosis for a baby. Modern equipment and qualified specialists are able to organize an effective process of caring for premature babies in the first days of life. In the future, the care of the child falls entirely on the shoulders of the parents.

First of all, this is the creation of a favorable environment for the child, it is also necessary to protect him from external risk factors, such as infection and stress.

The first days after the birth of a premature baby

Pregnancy is almost always a joy. And happy parents begin to calculate the timing of childbirth in order to have time to prepare. But it often happens that the baby, contrary to the expectations of parents and doctors, is born ahead of schedule. Babies born before 37 weeks are called preterm.

As a rule, these children have a body weight and height that is much less than the established standards. The modern equipment available in the arsenal of doctors today, used in the care of premature babies, gives them a better chance of survival. But even 15-20 years ago, such kids had practically no chance. nine0005

The first days are the most critical and decisive. After all, his lungs have not yet fully developed, and it is difficult to breathe on his own. At this time, the child needs specialized care, which should be provided by doctors in the maternity hospital. They put him in a special box - a couvez, where a special microclimate is organized for him.

The microclimate in the incubator is comparable to the climate in the mother's womb, where the baby has been in the last months. The air mixture supplied there has a high percentage of oxygen content. All organs of the baby are still immature and he needs specialized care of medical personnel and constant monitoring. nine0005

But now the time has come for discharge, after which the child completely passes under the care of the parents. And if there are no particular problems with hospital provision of the necessary conditions, then parents need to be taught the rules for caring for premature babies, because at home it is rather difficult to protect him from various infections.

Features of caring for a premature baby at home

The main problem of is the underweight of the newborn. It is in the last weeks of pregnancy that the weight of the child increases and a protective fatty layer is formed, which provides sufficient skin nutrition. In this regard, parents have to pay great attention to the moments of newborn skin care, the fight against diaper rash and irritation. nine0005

It is necessary to look through the delicate skin of the child at each swaddle. Careful attention should be paid to the choice of diapers. Preference should be given to soft natural fabrics, as well as carefully choose detergents and powders for washing baby clothes.

It is strictly contraindicated to swaddle the baby in an elastic manner. This will avoid chafing on the skin. But the main reason lies in the fact that the bones of the child and the respiratory organs are still weak, it can simply be difficult for him to breathe, moreover, the blood circulation does not yet function properly. nine0005

The next important point is ensuring optimal and comfortable temperature conditions in the house and in the baby's room in particular. The absence of subcutaneous fat makes the baby vulnerable to the surrounding climate, which makes the risk of infectious diseases many times higher. For this reason, the temperature regime should be monitored with a thermometer. The temperature in the room should be 22-24 ^o C.

Change your baby's clothes as soon as possible, using warm underwear and diapers. It should also be kept in closed spaces where it is easiest to provide the desired temperature: strollers, cradles. Overheating the baby is also dangerous, for this reason it is important to check the temperature around the baby regularly. nine0005

Feeding

Caring for a premature baby at home has a number of rules during feeding. This applies not only to compliance with the frequency of feeding procedures, but also to the features of the process. First of all, it is important to consider that the process of sucking for a premature baby is a lot of hard work. The lungs are still weak, and the process of sucking milk requires holding the breath. As an alternative to breastfeeding, expressing milk is often recommended. Then feed them to the baby through the nipple. After feeding, immediately put the child in the cradle or crib should not be. The fact is that premature babies spit up more often and more abundantly than healthy children. You should hold the child in your arms in an almost vertical position or laying on your shoulder. nine0005

Bathing

Bathing procedures should be daily. The water temperature should be 37 degrees, closer to six months, and as the baby gets stronger, you can lower it to 35 degrees in order to harden.

Walks

Walks should be more careful. In summer, they can be started already on the third day after discharge, and in winter - no earlier than 7 or even 10 days later. The duration of the walk is up to 15 minutes. The first exit can be limited to a 5-minute walk, and then gradually increase the time of walking with the baby on the street. nine0005

Anesthesiologist-resuscitator Ivashevich A.S.

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.

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nine0016 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.

Babies born before the 37th week of pregnancy are considered premature. nine0044 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. nine0005

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. nine0044 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. nine0044 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 developing diseases. 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 premature infants who are breastfed is ten times lower than those who are formula fed. nine0044 13 That's why every drop counts!

Most importantly, preterm 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. nine0044 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 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. nine0005

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. nine0044 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 has mastered 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 reproduces the rhythm of the suckling of the baby, 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. There are many ways you can participate in the care of your premature baby - 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. nine0005

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 to 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. nine0005

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? nine0089

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 breast milk, so you can put some milk on the nipple before you put 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. nine0005

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 linked: http://www.who.int/mediacentre/factsheets/fs363/en/

2 Duttaroy AK. Transport of fatty acids across the human placenta: a review. nine0004 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.

11 Patel AL et al. Influence of own mother's milk on bronchopulmonary dysplasia and costs. Arch DIS Child Fetal NEONAT ED . 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." nine0004 Perinatol wedge. (Clinical perinatology). 2010;37(1):217-245.