Feeding your baby is probably the first – and one of the strongest – maternal instincts there is, and if you thought about your deliveryroom experience, you may have imagined breastfeeding your baby in the first few minutes after birth. Or you may not have thought about breastfeeding – or you have decided to feed your baby with infant formula. But now your baby is in the NICU, and you have been asked – and possibly encouraged – to provide breastmilk for your baby. Whether you are a committed breastfeeder, or just thinking about it, here’s what you need to know.
Breastfeeding vs. breastmilk feeding
You may or may not have imagined yourself breastfeeding your baby. Now that your newborn is in the NICU, people are encouraging you to “breastfeed,” but that’s not really what we mean even though that’s what we say! Actual breastfeeding is very difficult in the NICU: your baby may be too small or too sick to actually nurse at the breast, may be too sick for any food to go into his/her tummy, or may have tubes in his/her mouth and throat that prevent nursing. You may not be able to hold him/her yet, and you can’t be there all the time to breastfeed every three hours. The truth is, although sometimes you can start breastfeeding while your baby is still in the NICU, breastfeeding is best worked on at home. But breastmilk is the perfect food for your baby and your clinical team would like to have some to feed to your baby for as long as possible. That breastmilk comes from you, and to get it to your baby, you will need to pump your breasts, collect the milk, and store it until you can bring it to the NICU. Many mothers had planned to breastfeed, so pumping is not an odd suggestion. But if you weren’t planning to breastfeed, the idea of pumping your breasts and collecting your milk may surprise -- or even disgust you. The importance of having fresh breastmilk to feed your baby cannot be overstated, and it is something only YOU can do! Many women find that providing breastmilk helps them bond and feel connected to their babies during the difficult NICU period. Pumping is not hard. Your NICU nurse and/or lactation consultant will help you!
Breastmilk – the perfect food.
Breastmilk is the perfect food for human babies, and providing milk for their young is one of the characteristics unique to mammals. Each species produces milk that is ideal for their own babies, and human milk is no different. There is no doubt that human milk benefits babies and that these benefits are life-long. Breastmilk contains lots of antibodies and growth factors and living cells that protect and nourish the growing infant. Breastfed babies have less frequent ear infections and colds as infants, fewer allergies as children and, as adults, have lower incidence of certain cancers. Breastmilk also benefits brain growth and development, and can make you smarter! When a baby is born prematurely, providing breastmilk to feed can help provide some of the nutrients that should have passed across the placenta had the pregnancy continued, and can minimize the risk of many of the complications of prematurity. And regardless of term or preterm, a sick baby will benefit from breastmilk feeds, which are better tolerated and provide growth factors, anti-inflammatory components, and other bioactive substances to promote healing.
For the preterm baby, whlie “breastmilk is best,” it is not adequate to be the sole source of nutrition, and your clinical team will recommend special additives to increase the calories, nutrients, and minerals in your breastmilk to meet the needs of a growing premature infant. Your baby may go home feeding on a cocktail of breastmilk mixed with formula powder to boost its nutritional composition. This does not mean your breastmilk is “no good.” Except in very rare situations, breastmilk is the best way to feed your baby.
Your milk will not “come in” immediately after birth, you may not be able to produce breastmilk, or you may choose not to. In these situations, because breastmilk is so much better than formula feeding, your NICU may offer donor breastmilk. This is milk that has been collected from lactating women, tested to be free from infection, processed and stored in a milk bank, not unlike blood collected from blood donors and stored in blood banks. Although women who donate milk are tested for the same infections as are blood donors, donated milk is pasteurized for extra safety. While pasteurized donor milk retains many of the health benefits of maternal milk, the pasteurization process does destroy some of the bioactive substances so it’s not as beneficial as maternal milk (but still better than formula). There are many barriers to offering donor breastmilk, and it may not be an option in every hospital. Some women choose to provide milk from private donors. While “wet nursing” has been in practice around the world for centuries, it is not condoned by the traditional western medical establishment. Many hospitals in the United States will not knowingly feed an infant breastmilk that did not come from his/her mother.
Many women cannot or choose not to provide breastmilk for their baby. In the United States, a variety of specially developed infant formulas are widely available, many advertised as being particular suited to certain feeding problems. Some of the formulas used during the NICU are only available while your baby is in the hospital, so s/he will have to be transitioned to another type before discharge. The two major formula brands in the United States, Similac® (produced by Ross Laboratories) and Enfamil® (produced by Mead-Johnson), are of high quality and are widely available. Both companies have big research programs that are continually working to improve their products. See for more information about their products. Good Start® is another formula brand that is receiving wider distribution in the United States, and some hospitals offer this brand for their lower risk babies, or as a discharge formula.
• Preterm formulas When breastmilk is not an option, your baby may be fed with special preterm formulas designed just for premature babies. These formulas are only available in the hospital and are different than the formula given to term babies, containing more protein, calories, and minerals to more appropriately nourish the growing preterm baby. Most of these (and all) infant formulas use cows’milk proteins as their basis, although the elemental formulas are made up of the protein building blocks (called amino acids) and may be used in special circumstances. See “Nutrition” for a thorough discussion of neonatal nutrition.
• Transitional formulas Some time prior to discharge – or if you have a late preterm baby, s/he may be changed to a “transitional” formula that you can continue after discharge. These formulas are in-between term formulas and preterm formulas, providing an intermediate amount of calories and minerals. Scientific studies have failed to demonstrate that transitional formulas make any long term difference, and the American Academy of Pediatrics (AAP)’s Committee on Pediatric Nutrition does not endorse them, but many neonatologists and pediatricians utilize them. Furthermore, the powdered formulation is frequently used as part of the recipe for breastmilk fortifier for home use.
• Elemental formulas These formulas consist of proteins that have already been digested into their building blocks and are used for babies with particular feeding problems when breastmilk is not available. They are more expensive for parents to purchase on their own, and don’t taste good, so nippling babies may reject them for taste. They are extremely useful for babies with short gut and other intestinal abnormalities.
• Human Milk Fortifier This is a substance (powder or liquid) specially manufactured by the formula companies specifically to add to human milk to boost its nutritional content. It is not available outside of the hospital, and your baby should be transitioned to a different fortifier prior to discharge.