Baby in the NICU: Feeding Support
Giving your baby breast milk is one thing you can do to make sure your baby has the best start possible.
For babies in the NICU, breast milk is more than just a food – it’s a proven medicine. Feeding breast milk to a premature baby reduces the incidence and/or severity of many prematurity-related illnesses. Did you know that three major illnesses can also be reduced or prevented by giving your baby breast milk?
Breast milk helps reduce:
NEC
Necrotizing Enterocolitis is a serious illness that mostly affects premature newborns. The intestine or colon in the baby becomes inflamed and it damages the tissue in your baby’s digestive tract. It can cause tissue death and/or even a hole in the intestine. For some infants the NEC is mild but for others it is severe or even life threatening.
Late Onset Sepsis
This is a blood infection that occurs after about 3 days of life. The infection causes different complications like temperature instability, low heart rate and breathing rates, apnea, increased oxygen requirements, feeding intolerance and lethargy.
BPD
Bronchopulmonary dysplasia (BPD) is a form of chronic lung disease that affects mostly premature babies and may require ventilator assistance. This disease damages lung tissue, which can cause chronic respiratory issues or may get better over time.
Proven Breast Milk Benefits for Babies in the NICU
The benefits of breast milk last much longer than your baby’s hospital stay – in fact, these benefits last a lifetime. What are some the things breast milk does for baby:
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Improved Neurological Development³
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Increased Life Expectancy⁴
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Lower Lifetime Healthcare Costs⁵
The first hours and days after birth are critical for ample breast milk supply throughout a parent’s breastfeeding journey. In fact, the milk production process can be described as a continuum of 4 distinct stages.
Select each step for more information.
The development of breast tissue in preparation for breastfeeding, which occurs primarily during pregnancy when milk-producing cells begin to form.⁶
After birth, the nipple is stimulated by the newborn sucking and the cells developed during pregnancy are gradually “switched on”. This, along with hormonal changes in the mother after delivery, leads to secretory activation (i.e. milk “coming in”) about 2 – 4 days later.⁶
Post-secretory activation (after the milk starts to “come in”) is when milk production starts to increase. Frequent breastfeeding over the first month builds strong milk supply to meet the infant’s ongoing and long-term needs.⁷
By the end of the first month, a full milk supply is usually established, with term infants removing the same volume over 24 hours as they will do at 6 months.⁸,⁹
The development of breast tissue in preparation for breastfeeding, which occurs primarily during pregnancy when milk-producing cells begin to form.⁶
After birth, the nipple is stimulated by the newborn sucking and the cells developed during pregnancy are gradually “switched on”. This, along with hormonal changes in the mother after delivery, leads to secretory activation (i.e. milk “coming in”) about 2 – 4 days later.⁶
Post-secretory activation (after the milk starts to “come in”) is when milk production starts to increase. Frequent breastfeeding over the first month builds strong milk supply to meet the infant’s ongoing and long-term needs.⁷
By the end of the first month, a full milk supply is usually established, with term infants removing the same volume over 24 hours as they will do at 6 months.⁸,⁹
The “Initiate…Build…Maintain” stages are all interrelated, so it’s important to have a strong start. The Initiate stage between birth and milk coming in is most critical for future milk production because that is where you are charging your breast milk ducts for future use.
When you can’t put baby to breast or if breastfeeding is interrupted, stimulating the breast by pumping within the first hour after birth can lead to significantly increased milk production later.¹¹
Pumping replaces or supplements breastfeeding if the baby cannot remove milk effectively and/or is unable to nurse during the Build and Maintain phases.
That’s why, for pump-dependent mothers, a hospital-grade (multi-user) breast pump with Initiation Technology™ is recommended to Initiate, Build, and Maintain your milk supply. Ask any of your baby’s healthcare team how to access a hospital-grade (multi-user) breast pump with Initiation Technology in your area.
Pumping for NICU Baby
Getting Started - Pumping
It’s important to understand how to use your pump. Visit Symphony PLUS® Breast Pump Support | Medela for helpful videos on how to use the Symphony PLUS Breast Pump.
Don’t expect to get a full container of milk the first few times you pump. It can take several days before your milk comes in completely. Be patient and keep to the number of pumping sessions your healthcare team has recommended. Use this helpful and printable pumping log to keep your healthcare team up-to-date on your progress. Keep in mind that stress, discomfort, and fatigue can cause a slow start to milk production.
- Start pumping as soon as possible after giving birth.
- During your first pumping sessions, you will only see a few drops of milk.
- This is called colostrum.
- Use your breast pump at least 8 to 10 times per day.
- This will build a long-lasting milk supply.
- Pump for at least 15 minutes per session.
- Over the next several days, the amount of milk will increase over time.
- Pumping while your baby is in the NICU takes dedication. Don’t give up.
- Contact your Lactation Consultant, or talk to your baby’s healthcare team at the first signs of problems or concerns.
- Along with suction from your breast pump, using massage and hand expression can increase milk production.
- Hold your baby skin-to-skin – sometimes called kangaroo care – to help improve your baby’s ability to regulate and stabilize their body temperature, heart rate, breathing, and more.
- Which breast pump should I use if my baby is in the NICU?
- How does my milk help my premature baby?
- Address the difference or properties in mothers' milk
- Breast shield sizing:
- How do I determine size?
- When is it time to change breast shield size?
- Where can I pump?
- Where can I store my breast milk?
- How should I clean and sanitize my breast milk kit?
- What are the guidelines for properly labeling, handling, storing, and transporting my breast milk?
- What breast milk collection containers should I use?
- If using a Symphony PLUS Breast Pump, when should I switch from Initiation to the Maintain Program?
- Visit Symphony PLUS® Breast Pump Support | Medela for helpful instructional videos.
- What should I do if I have symptoms of flu/CV-19
- How much milk should I pump each day
- When will my milk come-in
- How frequently should I pump at night or skip night pumping?
- Feeding baby at breast, if your goal is to breastfeed your baby at breast, let your healthcare provider know and discuss when this may be possible before discharge
- When to request lactation support; decrease in milk supply, sore nipples, etc.
- Oral care
- Why is my baby in the NICU?
- What are your procedures for taking care of my baby?
- Who can visit my baby?
- What are the visiting hours?
- Who will be taking care of my baby?
- What tests are being performed on my baby?
- What is the diagnosis and please explain in words that I can understand?
- What type of support is there for my family?
- Is there housing available so that I can be close to my baby?
- What can I do to help take care of my baby?
- When will I be able to hold or touch my baby?
- When will my baby be ready to go home?
- What type of financial assistance is available?
- Johnson TJ et al. Neonatology. 2015; 107(4):271-276.
- Patel AL et al. J Perinatol. 2013; 33(7):514–519
- Patel AL et al. Arch Dis Child Fetal Neonatol Ed. 2017; 102 (3):F256-F261.
- Vohr BR et al. Pediatrics. 2006; 118(1):e115-e123.
- Mahon J et al. Health Econ Rev. 2016; 6(1):54.
- Rollins NC et al. The Lancet. 2016; 387:491–504. 1
- Pang WW, Hartmann PE. J Mammary Gland Biol Neoplasia. 2007; 12(4):211–221.
- Kent JC et al. J Obstet Gynecol Neonatal Nurs. 2012; 41(1):114–121.
- Kent JC et al. Pediatrics. 2006; 117(3):e387-95.
- Kent JC et al. Breastfeed Med. 2013; 8(4):401–407
- Parker LA et al. J Perinatol. 2012; 32(3):205–209