For a preterm newborn, breast milk is not only considered a food but also a fundamental part of the infant’s treatment.

Therefore, it is essential to know the different options available for oral feeding of preterm infants, to understand the differences between them as well as the pros and cons of each one.

The first choice for feeding a preterm newborn is always the mother’s own milk. It is the only milk that is specifically formulated for the baby.

• It starts with colostrum: a complex fluid richer in antimicrobial peptides, immunomodulatory components, and growth factors than mature milk that is produced in small quantities.
• In a mother with a preterm infant, the milk she produces is very similar to colostrum over a long period of time, unlike in term infants, where the transition to mature milk occurs within a few days. This milk is known as preterm breast milk, and its production lasts at least a month. It has been shown that it helps the infant’s organ systems to mature and protects against diseases specific to premature infants (necrotizing enterocolitis – NEC, bronchopulmonary dysplasia, retinopathy of prematurity, early and late sepsis, etc.).
• It has also been shown that there is an inversely proportional relationship between the amount of protective factors present in breast milk and the infant’s gestational age.
• Apart from the obvious benefits of the characteristics of this human milk, there are also benefits for the mother as well. If she wishes to breastfeed her child, the fact of stimulating the mammary glands to express milk will help her to maintain milk production and also favor the creation of the maternal bond, which can be hindered by prematurity.
• In some cases, when pregnant women are at risk of premature birth, they are already in contact with the health services. It is then recommended to get to know their wishes about breastfeeding, provide the necessary information and, if necessary, implement strategies that promote breastfeeding, such as antenatal colostrum harvesting, if possible, to start having reserves.
• There are milk expressing and conservation techniques that increase the fat content of human milk, a point that can be very interesting in some instances of very preterm infants: the so-called expressing by using the “hands-on pumping” technique, the use of glass containers and avoiding the use of plastic tubes to administer the milk and so on.

It is vital that the premature newborn does not lose weight during the first days when the mother has not yet experienced the onset of lactogenesis II or if there are difficulties in milk production. Then it may be necessary to administer donor human milk from a local milk bank.

Some processes can interfere with the onset of lactogenesis II: catecholamine secretion, maternal shock due to the birth process or the premature birth itself, administration of certain drugs, or some maternal pathologies associated with this premature birth.

Depending on the characteristics of the premature infant and under medical prescription, it is possible to resort to donor human milk from a milk bank if there is a local donor milk bank. Donor breast milk is the second feeding option for premature newborns.

• The main disadvantage of donor human milk is its limited availability; therefore, a responsible use of it is necessary since it is a very scarce resource. There are very specific requirements for it to be prescribed as food for premature infants.
• Regarding the previous points, it is logical that this is a second option because each mother produces a specific milk for her baby, therefore, the donor human milk will not be exactly formulated for the recipient of that donation.
• Finally, donor human milk must go through costly analysis and conservation protocols that can also modify its characteristics, such as the one that occurs in the pasteurization process for its subsequent conservation, which directly affects the cellularity of the milk.

Finally, if it is not possible to resort to either own or donor human milk, there remains the option of feeding the infant with formula milk.

• Formula-fed infants have been shown to have higher growth rates than infants fed with donor breast milk, but at the same time, the risk for necrotizing enterocolitis (NEC) has been found to be much higher in formula-fed infants than in breast-fed infants.

When caring for a family with a preterm newborn, it is crucial to provide accurate and detailed information about the options available and, of course, to subsequently support and help the family in the decision they have made.
To favor the evolution of the infant and also the future of this breastfeeding journey, it is extremely important to care for and support health and emotional aspects equally.

 

References

• Mathur NB,Acta Paediatr Scand 1990;79:1039-1044
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• Ronayne de Ferrer PA, Baroni A, Sambucetti ME, López NE, Ceriani Cernadas JM. Lactoferrin levels in term and preterm milk. J Am Coll Nutr. 2000 Jun;19(3):370-3. doi: 10.1080/07315724.2000.10718933. PMID: 10872899.
• Quigley M, Embleton ND, McGuire W. Formula versus donor breast milk for feeding preterm or low birth weight infants. Cochrane Database Syst Rev. 2019 Jul 19;7(7):CD002971. doi: 10.1002/14651858.CD002971.pub5. PMID: 31322731; PMCID: PMC6640412.
• Gianni ML, Roggero P, Mosca F. Human milk protein vs. formula protein and their use in preterm infants. Curr Opin Clin Nutr Metab Care. 2019 Jan;22(1):76-81. doi: 10.1097/MCO.0000000000000528. PMID: 30407223.
• Menchetti L, Traina G, Tomasello G, Casagrande-Proietti P, Leonardi L, Barbato O, Brecchia G. Potential benefits of colostrum in gastrointestinal diseases. Front Biosci (Schol Ed). 2016 Jun 1;8:331-51. doi: 10.2741/s467. PMID: 27100711.