Benefits for premature babies

How will breastfeeding help my premature baby?

Premature babies face many challenges. Breast milk can help overcome them. Research shows it boosts babies’ immune systems, protecting them from infection, and lowers the risk of several diseases, including a serious and sometimes fatal bowel disease, a chronic lung disease, and an eye disease that can cause severe eye damage. Premature babies who receive breast milk spend less time in hospital and appear to have better heart and brain development.

A) How breast milk protects premature babies

1) Breast milk components

Premature babies who receive breast milk get all the benefits that full-term babies get as well as additional benefits to help them  deal with their unique health challenges. The mother’s own milk is preferable but if not available, donor milk has many advantages over infant formula.

Even just putting small amounts of breast milk into the mouths of very small babies who are unable to feed helps them start feeding sooner and prevents excess inflammation (Martín-Álvarez 2020).

Breast milk has stem cells (Briere 2016) and antioxidants (Gila-Díaz 2020; Hanson 2016) that may protect and heal vulnerable areas such as the brain, gut, and lungs of  premature  babies and help their overall development.

Other breast milk components such as antibodies, lactoferrin, growth factors, enzymes, human milk oligosaccharides and beneficial microbes may also protect the baby from illness and promote optimal development (Beghetti 2019).

2) The milk of mothers of premature babies

The milk of mothers of premature babies is slightly different from that of mothers of term babies, with higher levels of fat, energy, and protein. These differences can persist for more than a month (Bauer 2011; Hsu 2014; Mills 2019; Sundekilde 2016).

The breast milk of mothers of premature babies has higher levels of some components to protect the baby from infection compared with the milk of term mothers. These agents include:

  • White blood cells and antibodies (Castellote  2011; Gidrewicz  2014; Moles 2015; Trend 2016) 
  • Lactoferrin (Gidrewicz 2014; Hsu 2014)
  • Human milk oligosaccharides (De Leoz 2012)
  • A certain fat (DHA) that may help the brain develop (Bokor 2007)

The breast milk of mothers of premature babies has unique micro RNA compared to that of mothers of term babies. This may have a role in growth (Carney 2017).

B) Short-term benefits of giving premature babies breast milk

Premature  babies have immature immune and digestive (gut) systems.

1) Easier digestion and fewer gut problems

Premature babies tolerate breast milk better than infant formula (Kumar 2017).

2) Necrotizing enterocolitis

Premature  babies are at risk of a serious bowel disease called necrotizing enterocolitis (NEC). The earlier the baby is born, the higher the risk. It is estimated that nearly 12% of babies born weighing less than 1,500 grams (3.3 pounds) will develop NEC and of those, about 30% will die. Treatment may include surgery and those who survive surgery may not develop as well in the long term.

There is good evidence the breast milk lowers the risk of premature babies getting NEC (Quigley 2014; Miller 2020).

3) Fewer infections

Breast milk provides immune protection as well as unique microbes and other ingredients (Moles 2015). It helps protect babies from infection in the following ways (Maffei  2017):

  • Increasing the acid level in the stomach, which kills harmful bacteria
  • Helping the gut to move milk and stool along
  • Making the gut less leaky
  • Supporting the growth of healthy gut microbes (the microbiome)

Babies who receive breast milk have fewer blood (sepsis) and other infections (El Manouni 2019; Hair 2016; Han 2020; Meier 2019).

4) Lower risk of dying

Because of the lower risk of infection and NEC, premature babies who receive human milk are also less likely to die (Hair 2016).

5) Spend less time in hospital

Babies who are fed breast milk spend less time in hospital (Ip  2007).

6) Breast milk and breastfeeding calms babies and relieves pain

Breastfeeding limits the amount of harmful stress babies experience.

Breastfeeding helps calm  them in the stressful setting of the modern hospital neonatal intensive care unit. Even the smell of their mother’s milk appears to calm premature babies and reduce their crying (Maayen-Matzger 2018; Zhang 2018).

One study (Carbajal 2008) showed that premature babies had about 10 painful procedures a day. Another study (Cignacco 2009) looked at premature babies on breathing machines (ventilators) and found that each baby had an average of 22 procedures, 75% of which were painful. Breastfeeding relieves pain during the medical procedures they may have to undergo (Reece-Stremtan 2016).

C) Long-term benefits

Breastfeeding and breast milk make babies healthier and more resilient to possible negative long-term effects of an early birth.

1) Better brain and nervous system development

Minimizing pain through breastfeeding and skin-to-skin care benefits the baby’s long-term brain development (Doesburg 2013).

Premature babies who receive breast milk have been shown to have the following:

  • Improved brain and nervous system growth and function, such as thinking, language, and non-verbal skills (Belfort 2016; Patra 2017; Pineda 2020)
  • Higher IQs (Meier 2019; Vohr 2006)
  • Better brain structure and connections between brain cells (Blesa 2019; Niu 2020)
  • Bigger brains (Chinea Jiménez 2017)
  • Higher levels of a hormone (nerve growth factor) that helps the brain and nervous system develop (Sánchez-Infantes 2018)
  • A lower risk of bleeding in the brain (Carome 2020)

Premature  babies who are breastfed, as opposed to infant formula-fed, after leaving hospital have nervous systems that develop better (Rozé 2012).

 2) Less chronic lung disease

Premature  babies and others who need mechanical breathing support are also at risk of bronchopulmonary dysplasia, a type of chronic lung disease. Of these babies, those who receive their mother’s milk appear to have a lower chance of developing this disease (Dicky 2017; Villamor-Martínez 2019).

3) Eye damage

Premature  babies are at risk of a disease of the eyes (retinopathy of prematurity [ROP]). It is caused by abnormal blood vessels growing into the layer of the eye that is critical for vision. These blood vessels can cause the layer to separate (retinal detachment), which causes blindness.  Babies who receive breast milk have more protection from ROP (Bharwani 2016; Zhou 2015).

4) Other benefits

Babies given breast milk appear to have a healthier body composition (Cerasani 2020; Piemontese 2018).

Children who were born premature and breastfed are more likely to have teeth that line up properly (da Rosa 2020).

Children who were born premature and received breast milk are less likely to be re-hospitalized. This benefit may persist until the age of five (Bentley 2018; Ip 2007; Nakamura 2020).

Adults who were born premature and received breast milk instead of infant formula appear to have better:

  • Heart development (El-Khuffash 2019).
  • Blood pressure and heart health (El-Khuffash 2019).
  • Heart function (El-Khuffash 2019; Lewandowski 2016).
  • Gut bacteria (Cacho 2017).
  • Growth of tissues such as muscle and brain and less growth of fatty tissue (Gianni 2018).

D) The importance of even small amounts of mother’s milk

Very small  premature  babies who are on a ventilator machine to help them breathe and are too sick to feed are often given tiny amounts of their mother’s colostrum or milk. These babies have been shown to (Gephart 2012; Rodriguez 2015):

  • Start oral feeds earlier (Mohammed 2020). 
  • Stop needing tube feeds earlier.
  • Gain weight better. 
  • Have more signs of immune protection (Moreno-Fernandez 2019). 
  • Have fewer signs of inflammation (Martín-Álvarez 2020).
  • Be less likely to develop NEC, pneumonia, blood infections, or die (Ma 2020; Tao 2020) .
  • Leave hospital earlier.
  • Be more likely to breastfeed.


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