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.

References

Bauer J, Gerss J. Longitudinal analysis of macronutrients and minerals in human milk produced by mothers of preterm infants. Clin Nutr. 2011 Apr;30(2):215-20

Beghetti I, Biagi E, Martini S, et al. Human Milk's Hidden Gift: Implications of the Milk Microbiome for Preterm Infants' Health. Nutrients. 2019;11(12):2944

Bentley JP, Burgner DP, Shand AW, et al. Gestation at birth, mode of birth, infant feeding and childhood hospitalization with infection. Acta Obstet Gynecol Scand. 2018 May 16

Bharwani SK, Green BF, Pezzullo JC, et al. Systematic review and meta-analysis of human milk intake and retinopathy of prematurity: a significant update. J Perinatol. 2016 Nov;36(11):913-920 
 
Blesa M, Sullivan G, Anblagan D, et al. Early breast milk exposure modifies brain connectivity in preterm infants. Neuroimage. 2019 Jan 1;184:431-439
 
Belfort MB, Anderson PJ, Nowak VA, et al. Breast Milk Feeding, Brain Development, and Neurocognitive Outcomes: A 7-Year Longitudinal Study in Infants Born at Less Than 30 Weeks' Gestation. J Pediatr. 2016 Oct;177:133-139.e1

Briere CE, Jensen T, McGrath JM, et al. Breast Milk Stem Cells: Current Science and Implications for Preterm Infants. Breastfeed Med. 2017 Apr;12:174-179 

Briere CE, McGrath JM, Jensen T, et al. Breast Milk Stem Cells: Current Science and Implications for Preterm Infants.  Adv Neonatal Care. 2016 Dec;16(6):410-419
 
Bokor S, Koletzko B, Decsi T, et al. Systematic review of fatty acid composition of human milk from mothers of preterm compared to full-term infants. Ann Nutr Metab. 2007;51(6):550-6
 
Cacho NT, Harrison NA, Parker LA, et al. Personalization of the Microbiota of Donor Human Milk with Mother's Own Milk. Front Microbiol. 2017 Aug 3;8:1470 
 
Carbajal R, Rousset A, Danan C, et al. Epidemiology and treatment of painful procedures in neonates in intensive care units. JAMA. 2008 Jul 2;300(1):60-70
 
Carney MC, Tarasiuk A, DiAngelo SL, et al. Metabolism-related microRNAs in maternal breast milk are influenced by premature delivery. Pediatr Res. 2017 Aug;82(2):226-236 

Carome K, Rahman A, Parvez B. Exclusive human milk diet reduces incidence of severe intraventricular hemorrhage in extremely low birth weight infants. J Perinatol. 2020 Sep 30

Castellote C, Casillas R, Ramírez-Santana C, et al. Premature  delivery influences the immunological composition of colostrum and transitional and mature human milk. J Nutr. 2011 Jun;141(6):1181-7 

Cerasani J, Ceroni F, De Cosmi V, et al. Human Milk Feeding and Preterm Infants' Growth and Body Composition: A Literature Review. Nutrients. 2020;12(4):E1155. Published 2020 Apr 21 

Chinea Jiménez B, Awad Parada Y, Villarino Marín A, et al. [Short, medium and long-term benefits of human milk intake in very-low-birth-weight infants]. [Article in Spanish] Nutr Hosp. 2017 Oct 24;34(5):1059-1066 

Cignacco E, Hamers J, van Lingen RA, et al. Neonatal procedural pain exposure and pain management in ventilated preterm infants during the first 14 days of life. Swiss Med Wkly. 2009 Apr 18;139(15-16):226-32

da Rosa DP, Bonow MLM, Goettems ML, et al. The influence of breastfeeding and pacifier use on the association between preterm birth and primary-dentition malocclusion: A population-based birth cohort study. Am J Orthod Dentofacial Orthop. 2020 Jun;157(6):754-763
 
De Leoz ML, Gaerlan SC, Strum JS, et al. Lacto-N-tetraose, fucosylation, and secretor status are highly variable in human milk oligosaccharides from women delivering preterm. J Proteome Res. 2012 Sep 7;11(9):4662-72
 
Dicky O, Ehlinger V, Montjaux N, et al.; EPIPAGE 2 Nutrition Study Group; EPINUTRI Study Group. Policy of feeding very preterm infants with their mother's own fresh expressed milk was associated with a reduced risk of bronchopulmonary dysplasia. Acta Paediatr. 2017 May;106(5):755-762 
 
Doesburg SM, Chau CM, Cheung TP, et al. Neonatal pain-related stress, functional cortical activity and visual-perceptual abilities in school-age children born at extremely low gestational age. Pain. 2013 Oct;154(10):1946-52
 
El-Khuffash, A, Jain A, Lewandowski AJ, et al. Preventing disease in the 21st century: early breast milk exposure and later cardiovascular health in premature infants. Pediatr Res. 2019
 
El Manouni El Hassani S, Berkhout DJC, Niemarkt HJ, et al. Risk Factors for Late-Onset Sepsis in Preterm Infants: A Multicenter Case-Control Study. Neonatology. 2019 Apr 4;116(1):42-51
 
Gephart SM, Hanson C, Wetzel CM, et al. NEC-zero recommendations from scoping review of evidence to prevent and foster timely recognition of necrotizing enterocolitis. Maternal Health, Neonatology and Perinatology. 2017;3:23 
 
Gephart SM, McGrath JM, Effken JA, et al. Necrotizing Enterocolitis Risk: State of the Science. Advances in Neonatal Care. 2012;12(2):77-89
 
Gianni ML, Roggero P, Mosca F. Human milk protein vs. formula protein and their use in preterm infants. Curr Opin Clin Nutr Metab Care. 2018 Nov 6
 
Gidrewicz DA, Fenton TR. A systematic review and meta-analysis of the nutrient content of preterm and term breast milk. BMC Pediatr. 2014;14:216. Published 2014 Aug 30

Gila-Díaz A, Herranz Carrillo G, Cañas S, et al. Influence of Maternal Age and Gestational Age on Breast Milk Antioxidants During the First Month of Lactation. Nutrients. 2020 Aug 25;12(9):E2569

Hair AB, Peluso AM, Hawthorne KM, et al. Beyond Necrotizing Enterocolitis Prevention: Improving Outcomes with an Exclusive Human Milk-Based Diet. Breastfeed Med. 2016 Mar;11(2):70-4

Han LY, Xu XJ, Tong XM, et al. [Effect of breastfeeding on the development of infection-related diseases during hospitalization in late preterm infants in 25 hospitals in Beijing, China]. Zhongguo Dang Dai Er Ke Za Zhi. 2020 Dec;22(12):1245-1250

Hanson C, Lyden E, Furtado J, et al.  A Comparison of Nutritional Antioxidant Content in Breast Milk, Donor Milk, and Infant Formulas.  Nutrients . 2016 Oct 28;8(11). pii: E681 

Härtel C, Spiegler J, Fortmann I, et al. Breastfeeding for 3 Months or Longer but Not Probiotics Is Associated with Reduced Risk for Inattention/Hyperactivity and Conduct Problems in Very-Low-Birth-Weight Children at Early Primary School Age. Nutrients. 2020 Oct 26;12(11):E3278
  
Hsu YC, Chen CH, Lin MC, et al. Changes in preterm breast milk nutrient content in the first month. Pediatr Neonatol. 2014 Dec;55(6):449-54
 
Ip S, Chung M, Raman G, et al. Breastfeeding and maternal and infant health outcomes in developed countries. Evid Rep Technol Assess. 2007(153):1-186

Kaingade P, Somasundaram I, Sharma A, et al. Cellular Components, Including Stem-Like Cells, of Preterm Mother's Mature Milk as Compared with Those in Her Colostrum: A Pilot Study. Breastfeed Med. 2017 Sep;12(7):446-449 

Lewandowski AJ, Lamata P, Francis JM, et al. Breast Milk Consumption in Preterm Neonates and Cardiac Shape in Adulthood. Pediatrics. 2016 Jul;138(1). pii: e20160050 

Kumar RK, Singhal A, Vaidya U, et al. Optimizing Nutrition in Preterm Low Birth Weight Infants-Consensus Summary. Front Nutr. 2017 May 26;4:20 

Ma A, Yang J, Li Y, et al. Oropharyngeal colostrum therapy reduces the incidence of ventilator-associated pneumonia in very low birth weight infants: a systematic review and meta-analysis [published online ahead of print, 2020 Mar 30]. Pediatr Res. 2020;1‐9

Maayan-Metzger A, Kedem-Friedrich P, Bransburg Zabary S, et al. The Impact of Preterm Infants' Continuous Exposure to Breast Milk Odor on Stress Parameters: A Pilot Study. Breastfeed Med. 2018 Apr;13(3):211-214 
 
Maffei D, Schanler RJ. Human milk is the feeding strategy to prevent necrotizing enterocolitis! Semin Perinatol. 2017 Feb;41(1):36-40 

Martín-Álvarez E, Diaz-Castro J, Peña-Caballero M,et al. Oropharyngeal Colostrum Positively Modulates the Inflammatory Response in Preterm Neonates. Nutrients. 2020 Feb 5;12(2):413

Meier PP. Human Milk and Clinical Outcomes in Preterm Infants. Nestle Nutr Inst Workshop Ser. 2019;90:163-174

Miller J, Tonkin E, Damarell RA, et al. A Systematic Review and Meta-Analysis of Human Milk Feeding and Morbidity in Very Low Birth Weight Infants. Nutrients. 2018 May 31;10(6):707

Mills L, Coulter L, Savage E, Modi N. Macronutrient content of donor milk from a regional human milk bank: variation with donor mother-infant characteristics. Br J Nutr. 2019 Nov 28;122(10):1155-1167

Mohammed AR, Eid AR, Elzehery R, et al. Effect of Oro-pharyngeal Administration of Mother's Milk Prior to Gavage Feeding on Gastrin, Motilin, Secretin, and Cholecystokinin Hormones in Preterm Infants: A Pilot Crossover Study. JPEN J Parenter Enteral Nutr. 2020 May 26

Moles L, Manzano S, Fernández L, et al. Bacteriological, biochemical, and immunological properties of colostrum and mature milk from mothers of extremely preterm infants. J Pediatr Gastroenterol Nutr. 2015 Jan;60(1):120-6 
 
Moreno-Fernandez J, Sánchez-Martínez B, Serrano-López L, et al. Enhancement of immune response mediated by oropharyngeal colostrum administration in preterm neonates. Pediatr Allergy Immunol. 2019 Mar;30(2):234-241

Nakamura K, Matsumoto N, Nakamura M, et al. Exclusively Breastfeeding Modifies the Adverse Association of Late Preterm Birth and Gastrointestinal Infection: A Nationwide Birth Cohort Study. Breastfeed Med. 2020 Jun 12

Niu W, Xu X, Zhang H, et al. Breastfeeding improves dynamic reorganization of functional connectivity in preterm infants: a temporal brain network study. Med Biol Eng Comput. 2020 Sep 18

Patra K, Hamilton M, Johnson TJ, et al. NICU Human Milk Dose and 20-Month Neurodevelopmental Outcome in Very Low Birth Weight Infants. Neonatology. 2017;112(4):330-336

Piemontese P, Liotto N, Mallardi D, et al. The Effect of Human Milk on Modulating the Quality of Growth in Preterm Infants. Front Pediatr. 2018 Oct 9;6:291

Pineda R, Muñoz R, Chrzastowski H, et al. Maternal Milk and Relationships to Early Neurobehavioral Outcome in Preterm Infants. J Perinat Neonatal Nurs. 2020 Jan/Mar;34(1):72-79

Quigley M, McGuire W. Formula versus donor breast milk for feeding preterm or low birth weight infants. Cochrane Database Syst Rev. 2014 Apr 22;(4):CD002971 

Reece-Stremtan S, Gray L. ABM Clinical Protocol #23: Nonpharmacological Management of Procedure-Related Pain in the Breastfeeding Infant, Revised 2016. Breastfeed Med. 2016 Nov;11:425-429. Epub 2016 Sep 13
 
Rodriguez NA, Caplan MS. Oropharyngeal administration of mother's milk to prevent necrotizing enterocolitis in extremely low-birth-weight infants: theoretical perspectives. J Perinat Neonatal Nurs. 2015 Jan-Mar;29(1):81-90

Rozé JC, Darmaun D, Boquien CY, et al. The apparent breastfeeding paradox in very preterm infants: relationship between breast feeding, early weight gain and neurodevelopment based on results from two cohorts, EPIPAGE and LIFT. BMJ Open. 2012 Apr 5;2(2):e000834 
 
Sánchez-Infantes D, Cereijo R, Sebastiani G, et al. Nerve Growth Factor Levels in Term Human Infants: Relationship to Prenatal Growth and Early Postnatal Feeding. Int J Endocrinol. 2018 Dec 23;2018:7562702

Sundekilde UK, Downey E, O'Mahony JA, et al. The Effect of Gestational and Lactational Age on the Human Milk Metabolome. Nutrients. 2016 May 19;8(5). pii: E304

Tao J, Mao J, Yang J, et al. Effects of oropharyngeal administration of colostrum on the incidence of necrotizing enterocolitis, late-onset sepsis, and death in preterm infants: a meta-analysis of RCTs. Eur J Clin Nutr. 2020 Jan 3

Trend S, Strunk T, Lloyd ML, et al. Levels of innate immune factors in preterm and term mothers' breast milk during the 1st month postpartum. Br J Nutr. 2016 Apr 14;115(7):1178-93

Villamor-Martínez E, Pierro M, Cavallaro G, et al. Mother's Own Milk and Bronchopulmonary Dysplasia: A Systematic Review and Meta-Analysis. Front Pediatr. 2019 Jun 6;7:224

Vohr BR, Poindexter BB, Dusick AM, et al. Beneficial effects of breast milk in the neonatal intensive care unit on the developmental outcome of extremely low birth weight infants at 18 months of age. Pediatrics. 2006 Jul;118(1):e115-23
 
Zhang S, Su F, Li J, et al. The Analgesic Effects of Maternal Milk Odor on Newborns: A Meta-Analysis. Breastfeed Med. 2018 May 7
 
Zhou J, Shukla VV,  John  D, et al. Human Milk Feeding as a Protective Factor for Retinopathy of Prematurity: A Meta-analysis. Pediatrics. 2015 Dec;136(6):e1576-86