Prematurity: Breastfeeding a 34-38 week gestation baby

Breastfeeding a 34-38 Week Preterm Newborn

Feeding volumes in preterm babies

• Term babies drink typical increasing volumes of milk each day in the first couple weeks. Click here to read about typical volumes. Small babies will drink less than this, but the volume varies greatly.
• An estimated volume can be calculated: Take the baby’s weight in pounds and multiply this by 2.5. This number is the number of ounces the baby likely needs in 24 hours.
  • Example: 5.5 pound baby X 2.5oz = 14 ounces needed per day.
• Push beyond this as needed in order to gain 1oz per day.
• All babies will eventually need at least 24 ounces per day, as with term babies. Many will reach 32 ounces per day.   

Latching

• Some babies born early need immediate medical attention, so they're not able to be skin to skin in the first hour after birth.
  • Learn to hand express colostrum within the first few hours, and do this regularly to stimulate your milk supply. Also consider pumping. 
• Preterm babies often have uncoordinated suck/swallow/breathing cycles.
• The suck reflex may be immature. A nipple shield can better trigger and sustain the suck reflex. 
  • They will likely be able to nurse without a shield over time, if you continue to try.  
  • Click here to view a couple videos about latching.

Feeding Devices: spoon, cup, syringe, bottle   

• In the first couple days, your baby needs only 5-10mL of colostrum for each feeding.
• If they won't latch and suckle it out, you can hand express it into a spoon or cup and directly feed it to your baby.
• If you pump, you can use a syringe to suck the few drops or mLs from the bottom of the pump bottle, and feed it to your baby with the syringe, while he suckles your finger. 
• Day by day, he'll need more at each feeding. Offer pumped breastmilk first, but if there isn't enough, offer donor milk or formula.
• As volumes increase, it will be easier to feed from a bottle, rather than to keep refilling a syringe. Some preterm babies can't get enough from a syringe, because it's hard to coordinate the milk flow from the syringe with the baby's suck-swallow-breath pattern. 
• People are often overly concerned that a baby will prefer the bottle over the breast.
• But, most babies will transition back and forth just fine, if you do paced bottle feedings. 

Triple Feeding is often necessary for preterm babies

• It is sometimes wise to limit your premi baby’s time at the breast to avoid feeding fatigue. After nursing, they will likely still need to take a bottle. Both you and your baby need rest. 
• Some premis need lots of prompts with breast compressions to stay awake and keep swallowing.
  • Click here  to view a video of an ideal breastfeeding session.

Do frequent weight checks

• Your preterm baby will need more weight checks than usual, to make sure all is well. 
• In the first 4 days, babies lose the extra fluid they're born with, and then ideally start to gain 1oz per day by day 4. The volume of intake needed to rehydrate and gain weight on day 4 - 8 is quite small. 
  • If your milk comes in and flows freely, your premterm baby can consume the small volumes quite easily and gain weight easily. However, caution is needed.
  • By day 10-12 or so, the volume needed to gain weight increases dramatically, and some premi babies lack the stamina to get it done. If they don't adequately remove the milk enough to gain 1oz per day, the milk supply may not get stimulated enough to establish a good milk supply. 
• Get regular weight checks every few days or more in the first couple weeks, to be sure all is well.