Breastmilk for premature babies

Your breastmilk is usually best for your premature baby. It meets most of their nutritional needs. It’s important for their development and growth. And it protects them from infection and illnesses.

If you give birth prematurely, your milk will be slightly different from milk at term. This is because your baby’s needs are different from those of a baby born at term.

Because premature babies need more proteins for growth than term babies, your colostrum will have more protein than the colostrum of mothers who give birth at term.

Your breastmilk will also have more of an enzyme called lysozyme. Lysozyme attacks certain bacteria and helps protect your baby from infections. And your breastmilk will have more fat and less lactose, because premature babies find lactose hard to digest.

Expressing breastmilk for premature babies

If your premature baby is 34 weeks or older, they’ll probably be able to have some breastmilk directly from your breast.

If your baby is younger than this, it might be weeks before they can try breastfeeding. But your baby can still have breastmilk. They might even be able to have small amounts of breastmilk from birth. Your baby will probably be given the breastmilk through a tube that runs from their nose or mouth down their throat into their stomach. They might be able to have breastmilk by bottle or cup, but this isn’t common.

If your baby is having your breastmilk through a tube, you’ll need to express either by hand or with a manual or electric pump. The hospital might have a pump for you to hire while your baby is in the neonatal intensive care unit (NICU).

It’s helpful to start expressing breastmilk soon after your baby’s birth – within an hour if you can. Then it’s good to express every 2-4 hours to establish and keep up your supply. Expressing at least once overnight also helps to keep up your supply.

Like breastfeeding, expressing breastmilk is a skill you need to learn. If you have trouble expressing, midwives, nurses or the hospital’s lactation consultant can help you.

If expressing breastmilk works for you, it’s one of the things you can do to feel close to and care for your baby. Our guide to expressing and storing breastmilk can help you get started.

Premature babies starting to breastfeed

Before your premature baby can feed directly from your breast, kangaroo care can be a great way to help them get comfortable with skin-to-skin contact. It can also help you to produce more milk.

When your baby is ready to start breastfeeding, you might find that progress can be quite slow, especially if your baby was born very early or has been very sick. Feeding is a complicated skill, and premature babies get tired very quickly. They might have only enough energy for breastfeeding once or twice a day.

During this learning time, your baby might get only a very small amount of milk from your breast, with the rest by tube.

It can take some premature babies many weeks to learn how to breastfeed.

Birthing mothers and babies do better at breastfeeding when they have support. The nursing staff or the hospital’s lactation consultant will help you with breastfeeding positions and breastfeeding attachment techniques. When you get home, your child and family health nurse, GP or the Australian Breastfeeding Association can also support you.

Breastmilk supplements and alternatives for premature babies

Supplements
If your premature baby was born very early, they’ll need extra nutrients for good growth. This means extra powdered protein and calories will be added to your breastmilk.

If your baby’s bone minerals are low, your baby will also get calcium and phosphate supplements to boost their bone growth.

Donor milk
If you can’t breastfeed or express your breastmilk, your baby might be able to have donated breastmilk. This might be possible if the hospital where you gave birth has a milk bank or access to the Australian Red Cross Lifeblood milk bank.

In Australia, donated breastmilk is pasteurised before it’s given to babies. Pasteurisation reduces the risk of infection, but it also reduces some of the nutrients and other properties of the breastmilk. But donor milk still has enough nutrients to help your baby grow and develop well. Extra protein and calories are usually added to it.

Formula milk
If your baby can’t have breastmilk or donor milk, they can have preterm infant formula.

If your baby can have breastmilk, there might be times when your baby’s doctor suggests that your baby needs feeds of infant formula as well as breastmilk to get extra nutrition. This is called mixed feeding.

If you need to do mixed feeding with your baby, it’s still important to breastfeed or express breastmilk for as long as you can. Many babies have a combination of breastmilk and formula, and any amount of breastmilk has benefits.

No matter how you’re feeding your premature baby, you’re also being there for your baby and providing comfort. A warm and loving relationship with you is an important influence on your baby’s development too.