Breastfeeding the Premature: Part 1

If mothers and full-term babies do not get good help with the initiation of breastfeeding in most hospitals, and they don’t, mothers and premature babies get even less help and more undermining of breastfeeding.

Part 1: premature babies need to be in incubators?

This is simply not true in most cases.  Premature babies (and full-term babies) in Kangaroo Mother Care (skin to skin contact for much of the day) are happier and stabilize sooner after birth.  And they are more stable even after the first hours after birth. They are generally more stable from the point of view of cardiovascular stability, gas exchange, blood pressure, blood sugar than babies in incubators.  Premature babies in KMC (Kangaroo Mother Care) are less likely to stop breathing for prolonged periods of time (more than 20 seconds is considered prolonged) or develop bradycardias (slow heart rate) when in skin to skin contact with the parents.  They maintain their skin temperature better as well.  Furthermore, studies show that skin-to-skin care of mothers with their babies during venipuncture (blood letting) had a pain-relieving effect. And, very importantly, they are more likely to begin breastfeeding earlier to leave hospital breastfeeding and exclusively and  when the mother and baby have been in Kangaroo Mother Care. And on top of all this, there is no evidence that breastfeeding requires more energy that bottle feeding, unlike what so many NICU staff believe.

Although this information has been readily available and published in peer-reviewed medical journals since the early 1980s at least, it seems that in most NICUs around the world, Kangaroo Mother Care is simply not done.

Here are just a few of the many articles showing the positive results of Kangaroo Mother Care for premature babies. More studies, but a complete list could go to hundreds of studies that are available in the scientific literature.

Föhe K, Kropf S, Avenarius S. Skin-to-Skin Contact Improves Gas Exchange in Premature Infants. Journal of Perinatology 2000;5:311315.

“During skin-to-skin contact, preterm infants not only remain clinically stable but also show a more efficient gas exchange. Although the patient is removed (transferred) from the incubator, there is no risk of hypothermia even in infants of <1000 gm.”

Charpak N, Ruiz-Peláez JG, Figueroa de C Z, Charpak Y. A Randomized, Controlled Trial of Kangaroo Mother Care: Results of Follow-Up at 1 Year of Corrected Age. Pediatrics 2001;108:1072-1079

“These results support earlier findings of the beneficial effects of KMC on mortality and growth. Use of this technique would humanize the practice of neonatology, promote breastfeeding, and shorten the neonatal hospital stay without compromising survival, growth, or development.”

Bergman NJ, Linley LL, Fawcus SR. Randomized controlled trial of skin-to-skin contact from birth versus conventional incubator for physiological stabilization in 1200- to 2199-gram newborns. Acta Pædiatr 2004;93:779-785

“Newborn care provided by skin-to-skin contact on the mother’s chest results in better physiological outcomes and stability than the same care provided in closed servo-controlled incubators. The cardio-respiratory instability seen in separated infants in the first 6 h is consistent with mammalian “protest-despair” biology, and with “hyper-arousal and dissociation” response patterns described in human infants: newborns should not be separated from their mothers.”

Nyqvist KH, Anderson GC, Bergman N et al. Towards universal Kangaroo Mother Care: recommendations and report from the First European conference and Seventh International Workshop on Kangaroo Mother Care. Acta Pædiatrica 2010;99:820-826

“Kangaroo Mother Care should begin as soon as possible after birth, be applied as continuous skin-to-skin contact to the extent that this is possible and appropriate and continue for as long as appropriate.”

Karlsson V, Heinemann A-B. Sjörs G, Nykvist KH, Ågren J. Early Skin-to-Skin Care in Extremely Preterm Infants: Thermal Balance and Care Environment. J Pediatr 2012;161:422-6

“SSC can be safely used in extremely preterm infants. SSC can be initiated during the first week of life and is feasible in infants requiring neonatal intensive care, including ventilator treatment. During SSC, the conduction of heat from parent to infant is sufficiently high to compensate for the increase in evaporative and convective heat loss. The increased water loss through the skin during SSC is small and should not affect the infant’s fluid balance.”

Luong KC, Nguyen TL, Huynh Thi DH, et al. Newly born low birthweight infants stabilise better in skin-to-skin contact than when separated from their mothers: a randomised controlled trial. Acta Paediatr 2016;105:381-390

“Skin-to-skin contact was likely to be an optimal environment for neonates without life-threatening conditions who weighed 1500–2500 g at birth. By preventing instability that requires subsequent medical treatment, it may be life-saving in low-income countries.”

A 20 year followup of premature babies by Charpak N, Tessier R, Ruiz G.  Pediatrics 2017;130(1):1-10. Conclusions: This study indicates that KMC had significant, long-lasting social and behavioral protective effects 20 years after the intervention. Coverage with this efficient and scientifically based health care intervention should be extended to the 18 million infants born each year who are candidates for the method.

Need breastfeeding help in Toronto and area? Book an appointment with the International Breastfeeding Centre.

Copyright: Jack Newman, MD, FRCPC, Andrea Polokova, 2017, 2018, 2021