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126 4.4 Preterm Infants
Breast milk is also better tolerated than formula ●● Prepare the breast through gentle massage
milk so can reduce the duration of parenteral before beginning to express.
nutrition.
●● Hand expression can be useful before pump
These benefits are dose-dependent so the more expressing or breastfeeding to initiate milk flow.
breast milk an infant receives the greater the
benefit to them. ●● Express regularly: a minimum 8–10 times per day.
Expressing breast milk for preterm ●● Don’t leave the gap between expression longer
infants than six hours.
Until their infant is old enough or well enough to ●● Express once at night – preferably between 2 and
feed directly from the breast, in order to supply 4 am.
breast milk mothers must express their milk. This
has benefits for both mother and child. Mothers ●● Ensure the breast is fully emptied before
often say that it is the one thing they can do for stopping expressing.
their preterm infant in an intensive medical
environment where skilled staff do most of the care ●● Make sure you are fully confident about using
for their infant. It also helps bonding and the breast pump.
attachment between mother and infant.
●● Check the funnel size as they come in different
Mothers of even the most preterm infants are sizes and can cause trauma if not fitting
able to provide all or some of the milk needed by correctly.
their baby to grow and develop (Bonet et al. 2011).
When infants are born extremely prematurely, ●● Where possible double pump from both breasts
breast development will be at an earlier stage than at the same time.
those of the mothers of term infants. Compensatory
breast growth can be achieved by efficient early ●● Engage in regular skin-to-skin contact (e.g.
and frequent milk removal by expressing. When kangaroo care).
mothers have given birth before 28 weeks gestation,
expressing their milk about 10–12 times in 24 ●● Sensory stimulation encourages oxytocin
hours for the first 2 weeks supports catch-up hormone levels and the let-down reflex. This
growth of the breast and effective initiation of may be by expressing beside the infant’s cot or
lactation. expressing with a picture of the infant and/or
toys/muslin cloths with the infant’s smell.
Ideally, mothers should initiate expressing
within 6 hours after delivery. Initially, hand Evidence suggests that mothers should be
expression will provide the first few drops of encouraged to express 750–1000 mL of breast milk
colostrum. After 2–3 days, as maternal milk in 24 hours by 2 weeks post delivery in order to
increases in volume, mothers can move to electric enable them to maintain long-term lactation. Once
pumping to express their breast milk. A trained lactation has been established, some mothers may
member of staff should ensure that mothers have be able to express less frequently to achieve this
the correctly fitting equipment and should show volume. The volume produced at each expression
them how to use the pump. depends on the glandular tissue content of the
breasts, which varies from mother to mother. Some
Maintaining lactation through expression for mothers can therefore produce larger volumes than
an infant born prematurely can be a long and tough others at each expression.
process, so mothers need good, consistent advice
and support from the outset. The following tips Nutrient content of preterm
may help them through the process: breast milk
Preterm breast milk, like term breast milk, starts
out as colostrum rich in protein and
immunoglobins specifically designed to help
