Is Preemie Formula or Breast Milk Better for Preterm Babies?

By Jordan Berns

Every pregnancy and every baby are different! There are preterm (premature), full term, late term, and post term babies. 12% of United States babies are preterm, meaning they were born before 37 weeks. Each preterm baby has slight differences due to gestational week growth and weight in grams. These factors can greatly vary their immune and gastrointestinal system needs.

Concerns that arise with premature babies are necrotizing enterocolitis (NEC), growth failure, late-onset sepsis, and missing developmental milestones. These risks become greater as birth weight and gestational age decrease. Thanks to scientific advances, ELBW (Extremely Low Birth Weight Infants) who are classified as weighing less than 1,000 grams, have a significantly higher survival prognosis than ever before.

One of the things that can potentially help premature babies is through the powers of evolution. A mother’s body and her breast milk adapts in the event of a premature birth. These mothers have breast milk with higher levels of protein and increased amounts of bioactive molecules (both boost babies’ growth rates) compared to women with full term babies.

Donor Breast Milk Differs from Premature Babies’ Mothers’ Milk.

Not all women who are able to give birth can produce breast milk, which is when generous milk donors jump in with assistance. Recent science has revealed that it’s actually healthier for preemies to be exclusively breastfed than to receive premature formula. Hospitals often rely on donor breast milk, usually from mothers who are producing mature milk for full term babies. To make this full term milk optimal for premature babies, it has to be combined with a fortifier that adds proteins, calories, and vitamins.

Unfortunately, donor milk is not always the perfect answer. Donor milk has insufficient nutrition markers for premature babies and the milk needs to be pasteurized (which reduces amounts of vitamin D). Hospitals also face a high demand, but low supply. Preterm milk is better for meeting preemie needs. Premature milk has more fats, copper, protein, zinc, sodium, and free amino acids than full term donor milk. A mother of a preterm baby has milk that supports growth rates and minimizes cases of NEC. Doctors recommend that NICU moms should start pumping 6-12 hours after delivery and try to pump 8-12 times a day, aiming to empty the breast with each pumping session. When bringing pumped milk into the NICU, mark and color code it so the hospital can identify which bags are colostrum (milk that arrives immediately postpartum and has the highest fat content) and which bags are mature milk.

The American Academy of Pediatrics has declared that the gold standard for premature babies nutritional needs is donated breast milk rather than exclusive preterm formula (in the event the baby’s mother cannot produce enough supply on her own). Top scientists now say that breast milk lowers blood pressure, reduces leptin and insulin resistance, decreases cases of metabolic syndrome, and encourages low-density lipoprotein levels. Breast milk usage also shows lower rates of NEC, late-onset sepsis, and fewer instances of re-hospitalizations. For every 10 ml/kg dose a baby receives, the data reveals a 5% reduction in the rate of hospital readmission.

In NICUs, a fortifier of bovine milk is added to breast milk to raise protein levels which supports accelerated growth. There is an ongoing debate if fortifier added to breast milk should be powder or liquid. Powdered fortifier has been linked to some instances of sepsis and neonatal Corynebacterial infections (a rare, food-borne illness that infects blood or causes the barriers protecting the brain and spinal column to swell). Using liquid fortifier is safer, but it can displace breast milk in terms volume of consumption.

NICU babies may have some trouble nursing and latching correctly when moving from tube feeding to breastfeeding. Skin-to-skin contact can help (it also encourages milk production!). Non-nutritive sucking (after pumping to empty the breasts) could potentially begin at 28 weeks. It’s possible for premature babies to begin nursing for sustenance at 32 weeks. The football and cross-cradle hold, which support the baby’s head and mother’s nursing breast, can be a game-changing breastfeeding position. Additionally, nipple shields may help babies nurse for longer periods of time.

All new mothers experience a degree of stress, and having a baby in the NICU can certainly be a very stressful situation. Stress and sleep deprivation can also reduce the amount of milk that is capable of being produced, which is just one of the many reasons to take care of yourself during this time! All of this can seem really overwhelming, so having a conversation with a lactation consultant can help set NICU mothers up for a successful and enjoyable breastfeeding experience. Here at Lactation Lab, we offer virtual appointments with our in-house lactation consultant, doctor, and nutritionist. No matter if you decide to breastfeed or not, or for how long you do, a good support system can help raise up those who are doing the child raising.