The Importance of Breastfeeding in Premature Infants

As mothers prepare for the task of bringing their new life to the world, it is crucial to encourage the consumption of human breast milk to premature infants. The female human body is equipped and engineered to naturally produce milk during pregnancy. Since the production of milk is natural, it is one of the prime sources of nutritional feeding for a premature infant. Breast milk contains a combination of various proteins, vitamins, carbohydrates, and even immunizing properties that enhance premature infant growth and overall health. According to Hurst and Levy, “the World Health Organization (WHO) and the United Nations International Children’s Emergency Fund (UNICEF) recommend exclusive breastfeeding for the first 6 months…”. The importance of breastfeeding in premature infants include an increase their immune system, decrease incidence of necrotizing enterocolitis, and decrease premature infant hospital stay.

Premature Infant Immunity

The characteristics that consider an infant to be premature are those born with a gestational period of less than 37 weeks. At 37 weeks of gestation, infants have just reached the cusp of lung maturity and have not finished developing fully, which place them at an increased risk of health complications, including infection and diseases. Several benefits of breast feeding in premature infants decrease incidences of diseases that include, but are not limited to, a decline in obesity, allergies, diabetes mellitus type 1 and 2, celiac disease and inflammatory bowel syndrome, childhood leukemia, and sudden infant death syndrome. As the mother exclusively breastfeeds, immunizing properties in the breast milk are transferred. These properties consist of maternal antibodies that provide protection to the premature infant.

As the premature infant has not fully developed their own immune system, the maternal antibodies function could decrease “respiratory and GI infections, decreased incidence of otitis media, and [decreased] risk of bacterial meningitis and sepsis”. Optimizing the exclusivity of breastfeeding can shield the premature infant from such diseases and infections.

Necrotizing Enterocolitis in Premature Infants

Many complications arise as infants are born prematurely, but a unique complication of this group is necrotizing enterocolitis (NEC). NEC is described as a “life threatening condition characterized by acute mucosal necrosis in the intestine that affects mostly premature infants within the first 2 weeks of life…”. As stated before, infants have a lowered immune system as they have not fully developed compared to term infants. NEC has higher risk factors in premature infants who were bottle fed formula. The understanding of premature infants with lowered immune systems correlates with increasing breast milk intake that provides the supplements and protective barriers to reduce this specific complication.

Decrease Premature Infant Hospital Stay

Generally premature infants tend to require keen attention due to their early birth. This causes the infant to have a prolonged stay at the hospital, extending separation between the mother and her premature infant in the event that the mother is discharged at an earlier time. According to Assad, Elliot, and Abraham the duration of the hospital stay was shorter in the group of premature infants who consumed solely breast milk by 4.5 to 22 days. This duration was compared to another group of premature infants who were fed both breast milk and formula, which was one of the longest durations of hospital stays. To further enunciate the value in exclusively breast feeding in premature infants, the duration of hospital stay shortens due to the increase of nutrient supplementation. The interrelationship between shortened duration of hospital stays and breast milk as the key source to implement this nutritional augmentation is illuminated. The outcomes can establish a healthier premature infant, maximize the relationship with the mother during breast feedings, and encourage weight gain.

Nursing Implications

As an Obstetrics Nurse, we must find ways to maximize the best patient outcomes while remaining patient centered. Encouraging exclusively breast milk feedings in premature infants will optimize the health and overall well-being of the premature infant. Correspondingly, the time the mother spends with the infant is maximized which increases the bond outside of utero. The emotional connection of both the mother and the premature infant make strides toward the improvement of health overall. As nurses we can encourage exclusively breastfeeding premature infants by assessing the mother motivation to want to breastfeed and educating the positive outcomes. Nurses can further refer them to their primary physician for more in depth questions that are outside of the nursing scope of practice. Nurses can facilitate this by aiding them to write down questions that they may want to ask their primary physician beforehand, being attentive to concerns, and facial expressions in regard to the topic. Nurses can also demonstrate the effectiveness of breastfeeding by weighing the premature infant and measuring their length daily to provide accurate and visual confirmation of the improving outcomes. This can provide an authentic trend of the premature infant’s improvement and validate the implementation.

Clinical Unit Implementation

At MacNeal Hospital, nurses are propelled to reiterate and encourage breastfeeding in premature infants. Significant factors used at MacNeal Hospital include the teach back method. The nurse will enter the room and assess the mother’s readiness to learn how to properly latch the infant onto the breast. Once motivation is established, nurses stay in the room to assess and aid in the process of latching onto the breast. They use touch to respectfully correct incorrect latching by showing the mother how to properly hold the baby and hold the nipple to correct the latch. This is usually about a 10-minute observation. If the mother is successful, the nurse allows privacy but checks on the mother approximately towards the end of the feeding (usually 30 minutes per feeding). If the mother cannot successfully latch, the nurse encourages pumping breast milk as the second option. The nurse demonstrates how to set up the breast milk pump and orientates her on how to effectively pump breast milk. This method in implemented in all patients, whether primigravida, multigravida, and grand multipara. Reorientation and teach back is seen to be effective as some mother’s state that their last pregnancy is elongated from current pregnancy and such breastfeeding pumps have been altered and changed. It is noted that formula feeding is the last resort used when premature infant cannot latch properly and does not tolerate breast milk via bottle.

Summary

To conclude, the importance of breastfeeding in premature infants is to increase immunity, decrease occurrences of necrotizing enterocolitis, and decrease premature infant hospital stay. Due to their premature gestational birth, premature infants are born with a decreased immune system. This leaves premature infants at risk to contract diseases, such as diabetes type 1 and 2, or infections, such as meningitis and sepsis. Exclusively breastfeeding premature infants can increase their influx of maternal antibodies that help them protect their immune system as they continue to develop.