Just a question about pre-term babies and breast feeding

[lubu]

Not important to me but out of interest, I just wondered whether it is regarded as better to bottle or breast feed pre-term babies. It came up in conversation today that a friend of a friend was told by midwife to bottle feed as it is better for pre-term babies as it has got more nutrients etc. Not relevant to me, but I remember in discussions with my midwife that she said breast milk naturally adjusts to accomodate the different needs of a pre-term baby and is therefore highly recommended - if possible.

Just interested about who is right, or are both theories correct?

Sorry - when I say "not important to me" I mean that I haven't got a pre-term baby. I was just interested in the science of it all, if that makes sense?

It is never better to bottle feed. In fact more important to breastfeed as a preterm baby has an immature gut. That midwife was talking B*llocks!

Lubu, in the vast majority of cases, it is better to breastfeed. Breastfeeding provides antibodies and other protection that formula, at the moment, unfortunately cannot and is, in that sense, "custom made" for each particular baby.

Some women cannot or should not breastfeed (eg chronic or acute conditions which require the mother take drugs unsafe for the baby) and they rely on formula. A large amount of research has gone into the formulas, and more is being done (at the instigation of institutions such as the American Academy of Pediatrics and the European Society for Paediatric Gastroenterology Hepatology and Nutrition -- the main ones here and there) and the hospital should advise on which formula is appropriate for the child.

One thing I don't know is if drugs which are safe in moderation while breastfeeding a full term infant are inappropriate for a preterm infant (eg, a glass of wine or five ). My guess is yes-- the mother would have to watch her food, drink and drug intake for a while.

Sorry Eulalia, posts crossed, mine was not in response to yours. I'm just slow.

Thanks for responding. I think she was struggling with supply once she got home (baby feeding all the time etc) but the first midwife just said it would get better and the 2nd told her to give a bottle! There may be more to it than that and I agree that a relaxed mother is a better mother but I am sure that more could have been done to help with breast feeding first IMHO.

Another friend of another friend had same problem with a full term baby and I suggested NCT breast feeding councillor sp? and she is still feeding and loving it.

Ho hum - just makes me sad really, when someone wants to and gives up on bad advice.

A lot of drugs which you can take while breastfeeding you can also take while pregnant so from that point of view it doesn't matter about gestational age. Also there are often alternative drugs a mum can take for an illness which are Ok with breastfeeding. I have a link to a site which provides more info if anyone is interested.

Eulalia, I know you hate it when I say that-- that's why I felt bad about crossposting and not changing it slightly to avoid argument.

But look, I think of it this way:
"1 - a lot" times "1 - often" does not equal "never". And for those cases, if nothing else, it's important to know about formulas. (I'm arguing a point here, folks, I've got no beef or chicken or ham with families who choose not to breastfeed.)

More information would be better. My thought is that more information on the contraindications of breastfeeding would help the cause as more information is better and an admission that some people simply shouldn't breastfeed should be made in order to keep credibility. As well as the obvious other benefits.

I'm not trying to argue really -- I had this discussion today with a friend of mine on a different subject. It might turn out that I'm just not cynical enough.

Breastmilk is the superior food for preterm babies absolutely. Preterm babies are more likely to develop a life threatening illness called necrotising enterocolitis which is a diseaese of the bowel and is associated with formula milk. Women who cannot breastfeed would be encouraged to give their babies donated breast milk initially. In the special care baby unit of the hospial I work in all mothers are encouraged to express milk even if they do not plan to breast feed in the long term. The majority tend to do so.

Breastmilk is undoubtedly superior nutrition for all babies, whether pre-term or not. There is some controversy about the needs of pre-term babies to grow - breastmilk is not meant to grow babies quickly (unlike cows milk, which is great for ensuring calves grow quickly) and babies who are very pre-term may not grow very well on breastmilk alone....it's only very recently that very pre-term babies were able to survive so it's not surprising if breastmilk produced for these babies may need a boost. Currently, that boost is provided by fortifiers based on cows milk, but it would probably be better all round if there was a booster based on concentrated human milk...can't see it happening, though.

Eulalia - you can't say that drugs safe in pregnancy are therefore safe in lactation, or vice-versa. In fact, most drugs should be ok in breastfeeding (a few aren't). Drugs taken during pregnancy and drugs taken during bf may (or may not) reach the baby differently. It's all v. complicated and biochemical

That's excellent advice. And (seriously) I agree. Please list the places that have breast milk banks that can be tapped. And ways to tap them and where to call.

But otherwise, you encourage all mothers to express? Uhh, that goes to show how much you don't care. What if you had someone on long term steroids? Do you even think about that? What about PND with preterm infants? No exceptions? Who is more important? Does a child need a mother more than breastmilk?

grrr arggh.

Tiktok, darn you for posting in between. I was referring to Mears's post... yes I'm verrrrry slow.

JJ - don't want to clash with you here at all but where mothers are not on drugs that are contraindicated in breastfeeding, they are encouraged to express. It is about the only thing they can do to feel part of a preterm baby's care. (Have been there). Many women do express for their preterm babies but have no intention of breastfeeding. That has to be applauded because it makes a difference to their preterm baby's progress whether you like it or not. For mothers who cannot provide breastmilk, donated breastmilk is an option where I work.

By the way - steroids are not necessarily a problem when breastfeeding. There are many drugs that are supposedly contraindicated that are actually not!

Sorry, wasn't arguing against the expressing for babies who will not be subsequently breastfed. I was just saying that some people shouldn't breastfeed and that sometimes a milkbank isn't an option.

But, wrt the steroids, please refer to the previous equations which boils down to, just because some people can, doesn't mean all can. Kind of. I sort of assumed you all knew what I was talking about or would ask. Two equally valid solutions there.

And yes, I'm actively pointing people to the red book of Dr Thomas Hale. That was the most helpful book for me when I needed to take drugs and keep breastfeeding.

It's just that I care about people who can't or don't breastfeed. And, more importantly, it's interesting.

Milk banks are all listed here
I donate at present and was told pre-term babies are 10x more likely to suffer necrotising-enterocolitis fed on formula! so breastmilk for them can save 200 babies a year.

Thanks KMS. I think milk banking is a great thing and am not arguing against it or breastfeeding at all. It's just that I have a hard time believing that there is enough milk for all babies who need it. And donor information is here -- as I suspected, the guidelines for milk appropriate to feed premies are more stringent than those for full term infant (ie, even if you breastfeed, you might not be able to be a donor).

So, based on this conversation, three courses of action seem indicated:
-- encourage women who can and should breastfeed to express for their babies
-- encourage breastfeeding women who fit the donor guidelines to donate milk to milk banks
-- aggressively research and develop preterm formulas

All I'm really asking is for is an admission that sometimes, for whatever reason (lack of banked milk, mother who cannot breastfeed, whatever), babies are going to need formula. I think it is important to know about formulas, know which ones are appropriate for preterm infants as well as full term infants and advise women on what to feed their babies if they are not breastfeeding.

Promoting breastfeeding and knowing about formulas are not mutually exclusively. (Tiktok does both! )

You are absolutely right JJ that some babies will need formula. Referring to the original post, a midwife had said that formula milk has more nutrients for preterm babies. That is incorrect. In the past it was easier to have babies bottlefed in SCBU because it was a simple process to take it out of a prepacked bottle and put it down a tube. However, research showed the benefits of using breastmilk especially to reduce infections and rate of necrotising enterocolitis. There are very few mothers who cannot provide milk for their babies.
For those who cannot or will not, there are preterm formulas which may be used. Our unit does not have a milk bank but can access milk for very preterm babies where breastmilk is the ideal option.
Where there is an option, breastmilk is best. When there isn't an option, formula milk is a lifesaver.

I was a milk donor, too, and the milk bank fell over themselves thanking me. When I visited the bank (Rosie in Cambridge) they showed me babies I had helped, clearly they view real human milk as hugely beneficial to premies.