12: Breastfeeding and Human Milk for Preterm Newborns and Infants

Mother’s milk contains an array of active biological components that are important for immunity and growth. Mother’s milk is known to reduce the risk of necrotizing enterocolitis, late-onset sepsis, feeding intolerance, retinopathy of prematurity, and adverse neurodevelopment (Box 12-1). Mothers of preterm newborns face many barriers to producing milk, and many do not reach their intended feeding goals. Maternal barriers include (1) preexisting and pregnancy medical morbidities that contribute to delayed milk letdown (lactogenesis stage 2) or reduced milk production, (2) prolonged mother-baby separation that may last weeks to months while the newborn or infant is still hospitalized, (3) maintenance of milk production predominately by breast pumping rather than oral feedings at the breast, and (4) return to work or other logistical challenges that make frequent milk expression and infant visitation difficult. Preterm newborns have immature sucking and swallowing abilities, which often require tube feeding or special support when feeding directly at the breast, and nutrition requirements in macronutrients and micronutrients that exceed healthy newborns, requiring fortification of mother’s milk to optimize growth and development.