Human milk is recognized as the optimal feeding for all infants because of its proven health benefits to infants and their mothers. The World Health organization (WHO), the American Academy of Pediatrics (AAP), the American College of Obstetricians and Gynecologists (ACOG), and the United States Preventive Services Task Force all recommend breastfeeding for the first six months of life [1-5]. (See "Infant benefits of breastfeeding" and "Maternal and economic benefits of breastfeeding".)
However, mothers of vulnerable infants, such as preterm infants, encounter a variety of unique breastfeeding barriers and challenges that result in a decreased rate of breastfeeding in preterm compared with term infants [5,6]. As an example, in Massachusetts, breastfeeding initiation rates were 77, 70, and 63 percent in term infants, infants born between 32 and 36 weeks gestation, and those born between 24 and 31 weeks, respectively . These results emphasize the need to address the breastfeeding barriers in the maternal-preterm infant dyad, especially as the benefits of human milk are well-established in these infants. (See "Human milk feeding and fortification of human milk for premature infants", section on 'Advantages of human milk'.)
Breastfeeding the premature infant, including strategies to address the challenges unique to the infant-mother pair, will be reviewed here. The nutritional composition of human milk, fortification of human milk for premature infants, and approach to enteral feeds in the preterm infant are discussed separately. (See "Nutritional composition of human milk and preterm formula for the premature infant" and "Human milk feeding and fortification of human milk for premature infants" and "Approach to enteral nutrition in the premature infant".)
There is strong evidence that a combination of prenatal and postnatal educational and support interventions improve breastfeeding rates for all new parents, which is discussed separately. (See "Breastfeeding: Parental education and support".)
In the neonatal intensive care unit (NICU), further educational efforts are needed to address the specific breastfeeding needs of parents with preterm infants. In most cases, mothers who deliver prematurely have not made a final decision on whether to breastfeed their infant and may not have the necessary information to make an informed decision. Clinical staff should discuss the benefits of human milk, including the long-term effects of exclusive breastfeeding. In most cases, mothers opt to feed their infant breast milk, and are willing to express when they learn about the benefits of human milk .