Premature Babies
Mothers who deliver babies early make a higher calorie milk than mothers who deliver at term (24 cal/oz). Their milk also has a different solute load so it is easier for the pre-term kidneys to handle. This special milk is probably produced for the first 4-6 weeks.
Pre-term babies tend to have less organized behaviours as their nervous systems are not fully matured. This explains how they can have a rapid progression through several states in a short course of time. A developmentally sensitive care giver can learn to identify these state changes and the baby’s own personal language of cues.
We know that skin to skin is beneficial for all babies because it helps regulate heart rate, breathing patterns, and temperature. In a pre-term population when you monitor the O2 saturation levels of the baby we see an increase in these levels when they are held skin to skin. It is not hard to understand why Kangaroo Care is so beneficial to this special group of babies.
When we look at babies born early and how to best support breastfeeding we have many studies to draw from. Paula Meirer is a nurse researcher in the states that has looked at various feeding issues in this population including looking at how much work it is for this special population to breastfeed. She found that babies had less falls in O2 saturation levels at the breast as compared to bottlefeeding and they recovered faster back to their baseline at the breast than they did when they bottlefed. She has also proposed that pre-term babies may increase their milk transfer in the early days of feeding (prior to discharge) by using a nipple shield to initiate feedings at the breast. This has been received with mixed reviews in the Lactation Consultants Community.
When can babies start breastfeeding? Traditionally we have always said that co-ordination of suck/swallow/gag comes in around 34 weeks and that this was the optimal time to introduce oral feeds. If we take a more developmental approach we will observe the baby’s behaviour and cues and weigh this along with gestational age to make the best plan of care for each individual baby.
Oral feeds using a cup have been used as early as 30 weeks and continued until baby is able to get nutrition from the breast. When babies are given the opportunity to experience Kangaroo Care we often see them find their way to the breast similar to what term babies do at birth. The key to any good care plan is to adapt it to the baby rather than adapt the baby to the care plan.
Positionally we know that sucking is a flexor skill and we also know that babies born early tend to have lower muscle tone and tend to be in extension rather than flexion. It is therefore helpful, from a feeding perspective, to help the baby adopt a flexed posture during feeding. The under the arm (rugby/football) hold is a position that facilitates this. When babies are worn on mum’s body in a biological nurturing position the baby tends to adopt a more flexed position as well.
Developing a Plan
Initially start to express milk within the first 24hrs. Try to express 8 – 10 times in 24hrs. There is no evidence that longer sessions yield more milk. Short frequent sessions tend to give a better yield over 24hrs. Pump until the spray stops. Use a double pumping kit if available as this tends to take less time and yield more milk. Hire/borrow an electric hospital grade pump. Do lots of cuddles and skin to skin as medical conditions warrant. Offer opportunities for baby to smell your breastmilk ( breastpad left in isolate or cot).
Learn you baby’s cues and time out signals. Stress signals can include:- clenched fist with white knuckles
- fingers splayed
- cheeks and chin sagging
- furrowed brow
- arm bent at elbow with raised hand (stop sign)
- legs up as if in leg lift
- arching away
- averting gaze, turning head away
- yawns, hiccups
If you notice these behaviours allow the infant to rest and have a “time out”
Breastfeed on cue:
- quiet alert state, eyes wide and engaging
- mouthing
- licking
- searching
- hand to mouth
- crying is a late hunger cue and may further disorganize feeding behaviours.
Babies that are showing clear cues that are allowed to progress to a “cue based” feeding plan (modified demand) rather than scheduled feedings thrive and go home faster.
