Page 137 - MHF-FeedingMinds-final.indd

128 4.4 Preterm Infants

28 weeks gestation as an extension of ‘kangaroo Patience, practice and persistence are needed in
care’, but they are unlikely to achieve full nutritive the transition from tube feeding to breastfeeding.
breastfeeding until around 36 weeks gestation. Ongoing practical and emotional support from
staff trained in breastfeeding care is needed. They
Kangaroo care (Figure 4.4.3) involves the infant can observe and support breastfeeding attempts
being secured against the mother’s skin – usually and help mothers to:
on her chest between her breasts. This maintains
the infant’s body heat and the benefits for the infant ●● understand normal feeding behaviours of
include reduced morbidity and mortality. preterm infants

●● understand the development to effective
attachment and positioning on the breast and
sucking behaviours

●● assess success and progress of their infant’s
breastfeeding.

Physiological benefits for preterm infants of
breastfeeding rather than bottlefeeding include:

●● improved temperature control

●● improved oxygen saturations

●● improved suck swallow breathe coordination.

There is some evidence that breastfeeding
facilitates earlier discharge from neonatal units
than bottlefeeding (Altman et al. 2009).
Bottlefeeding may interfere with the development
of breastfeeding if introduced before breastfeeding
is fully established.

Figure 4.4.3 A baby being held in kangaroo care Bottlefeeding

As breastfeeding development is reliant on the If a mother chooses not to breastfeed, preterm
mother and infant dyad, every effort should be made infants can start attempting bottlefeeding once the
to enable mothers to be with their infant as much as infant is old enough and well enough to coordinate
possible. A general overview of breastfeeding suck, swallow and breathing; this is usually around
progression is summarized in Table 4.4.5. 34 weeks gestation.

Table 4.4.5 Overview of breastfeeding progression in preterm infants

Gestational age Breastfeeding skills of preterm infants
Less than 30 weeks
Smell, open mouth, protrude tongue, dribble saliva, lick milk from the nipple, take some
30–32 weeks breast tissue into the mouth, and make a few weak sucks

32 weeks and over Attach to the breast and may make some weak to strong sucks with long pauses in
between
36 weeks and over
Root, organize sucking bursts with long pauses, take part of a feed from the breast and
as he or she becomes older may take one to all complete feeds from the breast

Breastfeed in a well-coordinated way

From Lang (2002).