Breast milk for premature babies: practice early

A research project is investigating how all premature babies weighing less than 1,500 grams could have access to breast milk – for example with the help of milk donations.

Breast milk adapts very precisely to the development and required nutrients of the child Photo: Anders Thessing/Bildhuset/plainpicture

After the birth of her daughter, Jessica Hübel poured her breast milk down the drain for weeks. The child was born in the 31st week by caesarean section. Jessica Hübel had preeclampsia, also known as pregnancy poisoning, which results in severe high blood pressure. Because she had to take antihypertensive drugs long after the birth, her milk was initially out of the question for her daughter.

She was not alone in tipping over: in the neonatal intensive care unit, she met another mother who had to dispose of her milk because she was producing far more than the infant needed. “And of course I asked myself: why can’t she just give me her milk?”

It is scientifically undisputed that breast milk provides the best possible care for premature babies and can be vital for survival. For example, the risk of infections of the gastrointestinal tract, known as necrotizing enterocolitis, is much lower. Hübel’s daughter, who initially received artificial baby food, fell ill. Breast milk is also easier for premature babies to digest, promotes vision and brain growth.

Researchers have shown that children who are breastfed for more than twelve months later have a slightly higher intelligence quotient. A study in the journal NeuroImage was even able to show that the myelin sheaths, which optimize the transmission of stimuli from nerve cells in the brain, grow faster in the first year of life. The researchers suspect that this is due to the long-chain fatty acids in breast milk.

Especially in the case of premature babies, the milk adapts very precisely to the development and required nutrients. In addition to fat and carbohydrates, it contains hormones, proteins, enzymes, prebiotics and probiotics. Numerous studies show how favorable this composition is. According to the Federal Institute for Risk Assessment (BfR), breastfeeding reduces the number of infections by 40 to 70 percent in the first four to six months.

From a scientific point of view, sharing breast milk makes sense – and in some places it is possible. In Germany there are 30 human milk banks that redistribute milk from donors. However, there are 200 perinatal centers, i.e. facilities for premature babies. That said, only a few sites have access to these milk banks.

The fact that not every neonatology department simply sets up its own small milk bank is also due to legal ambiguities. “In Germany it is not precisely determined whether breast milk is a food, a drug or an organ donation,” says Nadine Scholten, health care researcher at the University of Cologne. As a result, federal states deal differently with donated milk. In some it needs to be pasteurized like cow’s milk – which reduces potency – in others it can be fed raw. Scholten and her team have therefore commissioned a legal report that is intended to create the basis for uniform rules.

Together with Till Dresbach from the Bonn University Hospital, Scholten is leading a major research project on breast milk for premature babies. The project called “Neo-Milk” will run until 2024. The federal government’s innovation fund is funding it with 4.7 million euros.

“You have to be able to see what you’re doing”

However, legal certainty when dealing with donor milk is only a small part of what the research project aims to achieve. After the end of the four-year study, the way should be paved so that at some point all around 10,500 premature babies born in Germany every year with a birth weight of less than 1,500 grams can be supplied with breast milk. Essential for this is on the one hand a comprehensive network of human milk banks and on the other hand the so-called structured promotion of breastfeeding.

Nadine Scholten says that in order for milk production to start after childbirth, you need to be close to the child, rest, feel good and be supported when pumping. Initial surveys of mothers whose children were treated in a neonatology department immediately after birth show that these aspects are often neglected. Handling the breast pump in particular can be tedious, frustrating and – if used incorrectly – painful at first. “We can see from our questionnaires that important time is often not used at the beginning, pumping is not discussed enough and, above all, skin contact with the children often comes too late.”

It would be beneficial to be able to look at your own child while the pump is working, but even that is sometimes not possible. For the first time, Jessica Hübel sits in a room specially set up for breastfeeding, “a kind of storage room” with uncomfortable plastic chairs and white partitions. “I then watched videos of my daughter on my cell phone,” says Hübel. “You have to be able to see what you’re doing.”

The Neo-Milk researchers also interviewed medical staff as part of the study, and “in general we can say that the relevance and importance of breast milk supply is seen,” says Scholten. But promoting breastfeeding takes time, staff are often scarce and powdered milk also nourishes the premature babies. Even small things in dealing with the mothers would help, for example regularly asking how well it works to address encouraging words to them.

Manuals, digital training courses, apps

Some pregnant women know that their child is likely to be born prematurely and are on the ward days or weeks before the birth. “This time could be used well to address the topic of breastfeeding and mother’s milk for premature babies, and to obtain colostrum if necessary.” Colostrum is the so-called first milk, which some pregnant women produce even before birth. These are usually only tiny amounts – but they are valuable. Colostrum contains a particularly large number of antibodies, white blood cells, vitamins, minerals and proteins. Far too often colostrum is simply lost, says Scholten, and this highly concentrated mix helps premature babies in particular with their immune system and digestion.

In order to sensitize employees to the topic of neonatology, the Neo-Milk team wants to publish a handbook that summarizes the current state of science on the effectiveness of breast milk for premature babies and measures to promote breastfeeding. They also want to design digital training courses for medical staff and develop an app for parents. With videos that explain which tricks help against breast engorgement, how pumping works and a push notification every few hours to remind you.

In the best case scenario, the two intertwine in neonatology: early breastfeeding support and the option of using donated milk if you cannot use your own milk, if it is a long time coming, if you do not want to breastfeed or cannot breastfeed. The time spent in NICU can be extremely psychologically stressful for parents, and breastfeeding is a socially charged issue that comes with a lot of pressure. This pressure is to be relieved by ensuring that human milk is available on the ward that suits the developmental stage of the premature baby and can bridge weeks until the mother produces enough herself.

But there is still a long way to go until then. By the end of the project, at best, 15 new human milk banks had already been set up, which are currently being tested and evaluated in 15 clinics. In order to make work easier for the clinics, the scientists from Bonn and Cologne want to set basic standards for human milk banks – and support start-ups. So that one day no more milk ends up in the drain that could fill someone up.