Doctors and nurses at Singapore General Hospital (SGH) hope to convince mothers that breast-feeding is the best gift for their premature babies. Dr Varsha Atul Shah, Senior Consultant, Department of Neonatal and Developmental Medicine, SGH, a member of the SingHealth group, called breast milk “liquid gold”, because of its amazing concentration of protective substances.

“Colostrum is the milk a mother produces right after delivery and, compared to other kinds of milk, it has the highest concentration of antibodies needed to fight the complications that may arise from premature birth,” she said. Mother’s milk is also highly effective in protecting a baby from infections such as meningitis and necrotising enterocolitis, a serious intestinal infection.

“By consuming mother’s milk, a baby effectively receives his first immunisation, because all the antibodies a mother has in her body will be passed on to him through her breast milk. No man-made vaccine can replicate that,” said Dr Varsha.

“Mother’s milk is specially designed to help a premature infant through those first difficult weeks. It is richer in proteins and has slightly different fats from later breast milk.”

Pre-term mothers make colostrum for a longer time than full-term mothers, so it is important to express as much of the milk as possible. Dr Varsha said it is essential for pre-term mums to express their milk within six hours of giving birth.

To ensure that milk production does not dwindle away due to a lack of breastfeeding, pre-term mothers should express their milk regularly – around eight times a day – as though they were breast-feeding a full-term child, Dr Varsha said.

• 28 weeks old or younger: Intravenous fluids plus intravenous nutrition
• 28 to 34 weeks old: Intravenous fluids and nutrition, plus tube feeding
• 32 to 37 weeks old: Tube feeding plus feeding by breast or bottle
• After 37 weeks old: Usually by breast or bottle. No more tube feeding
• 38 weeks old: A preemie reaches full term when it is about 38 weeks old. As an “ex-preemie”, it will still be relatively weak. Compared to full-term babies, it will still take a longer time to feed. When breastfeeding an “ex-preemie”, parents must watch out for problems with sucking, swallowing and breathing. As most preemies are not as adept at this sequence of actions, parents need to let them take breaks, so they can swallow the milk and catch their breath. If a baby starts getting blue around the mouth, it may be choking.

Preemies have relatively weaker neck muscles, so their heads need to be supported during breastfeeding. A mum should place her hands behind her baby’s neck, with her index finger and thumb lightly over her baby’s ears.

Gastro oesophageal reflux affects up to half of premature babies, causing them to spit up whatever they have ingested. Putting the baby on its tummy or side can help. Mums can also feed their babies more frequently, and with smaller amounts of milk each time.

Ref: S13