Benefits of Breastmilk

EHM asked Dr. Leon Mitoulas, Medical Research Director at Medela, about the advantages of giving preterm infants breastmilk.

The American Academy of Pediatrics states that “Hospitals and physicians should recommend human milk for premature and other high-risk infants either by direct breastfeeding and/or using the mother’s own expressed milk.” There is significant and compelling evidence that expressed breastmilk should be the first choice of nutrition for the preterm infant. While a mother’s own expressed breastmilk is ideal, there is a growing body of evidence that donated milk is the next best alternative.

Advantages

Breastmilk carries significant benefits for a preterm infant’s immune, gastrointestinal and brain development. For example, recent studies have shown that inclusion of breastmilk (be it the mother’s or donor milk) in a preterm infant’s diet significantly reduces the odds of infection and necrotizing enterocolitis (a serious and common gastrointestinal disorder among hospitalized preterm infants).

Additionally, numerous studies have concluded that children born prematurely and fed breastmilk score higher on IQ and developmental tests than those fed formula. The authors of a recent report on the subject noted that all efforts should be made to introduce all mothers to the benefits of breastmilk.

Providing breastmilk

The only way for mothers of babies in the NICU to express milk is through the use of a breast pump. For these mothers, an aggressive approach – including counseling the mother about the benefits of breastmilk, development of protocols for high-risk mothers before delivery and introduction of pumping as soon as possible following delivery – is recognized as the most successful way to establish lactation.

Recognizing that early milk production will be low, realistic expectations should be set so that mothers do not become discouraged; it is the early milk (or colostrum) that is of vital importance to the infant. Ideally, mothers should aim to produce approximately 750 ml of milk daily by day 10 postpartum. Mothers should be encouraged to express frequently, at least six to eight times in a 24 hour period. This is critically important, as long-term milk production is directly tied to breast stimulation.

Expressing breastmilk

The best place to start with expressing milk is with the breast pump. However, not all pumps are created equal. Mothers should use a high-quality, hospital grade electric breast pump, ideally one that is fully automatic and that produces a cyclic sucking rhythm mimicking infant sucking rhythms. The pump should be able to express both breasts simultaneously, which yields the best results and halves pumping time.

Mothers should be encouraged to pump at the strongest comfortable vacuum. Any stronger could be painful, and any less could decrease pump efficacy; either would reduce milk production. They should also ensure that they are using a correctly fitted breast shield. A breast shield that does not fit properly can compress the milk ducts, impeding milk removal. It could also cause nipple trauma, which can discourage pumping and result in less milk and long term lactation difficulties.

Additional factors that play a role in optimizing milk output are gradually becoming apparent in the medical literature, such as massaging the breast prior to and during pumping and keeping a written pumping log. A journal can be particularly helpful in establishing and tracking a pumping routine; it can also provide the NICU staff with information needed to address any potential lactation problems. Lastly, but perhaps most importantly, skin-to-skin care also augments milk production and preserves lactation, in addition to its other benefits to the infant.

NICU staff

NICU staff need to be aware of the importance of breastmilk to the infant and familiar with the evidence in the literature. Breastmilk, and therefore maternal lactation, is a necessary part of the preterm infant’s care. Staff should be familiar with the practical measures of establishing effective milk expression and encouraged to help each mother develop a personal expression plan. Only with the complete support of all NICU staff will the mother have the best opportunity to establish and maintain her lactation, ensuring that the infant will receive the best possible start to life.

Dr. Leon Mitoulas serves as the Medical Research Director of Medela’s Research Team, based in Baar, Switzerland. An expert in lactation physiology, Mitoulas’s doctoral and postdoctoral work focused on breastmilk composition and the physiology of breastmilk removal by the breastfeeding baby and electric breast pumps.