Advantages of breast milk feeding

The advantages of feeding the human newborn, even (or especially) the premature human newborn, his/her mother’s breast milk are too numerous too count. Enumerated below are only a few of the better understood ways breast milk feeding benefits babies.

Breast milk has a nutritional composition which is superior to proprietary formulas and promotes digestion and absorption of its nutrients in unique biological ways. The lipid profile of breast milk includes polyunsaturated long chain fatty acids (PUFAs,) which are utilized in brain and retinal development. Breast milk contains easily digestible whey protein (mostly a-lactalbumin) as well as other non-protein nitrogen sources, including urea and free amino acids, particularly glutamine and taurine. It also contains free nucleotides, carnitine, and inositol which are not readily available in all formulas. Breast milk also contains numerous antioxidant factors (cysteine, vitamin E, and ß-carotene) which may be particularly beneficial to the preterm neonate frequently exposed to a hyperoxic environment.

Breast milk contains enzymes which facilitate its digestion and absorption. The fat globules are specially arranged in breast milk, and lipoprotein lipase and bile-salt stimulated lipase are provided which improves lipolysis and fat utilization. Although breast milk contains only small amounts of iron and other minerals and trace elements, these nutrients are much more bioavailable than in formulas.

Breast milk offers remarkable immunologic benefits as well. Multiple bioactive factors are included in breast milk which function in host defense. Cellular factors are present as well as secretory IgA, lysozyme, lactoferrin, and oligosaccharides. Breast fed term infants have a lower incidence of otitis media and diarrheal disease. EBM-fed preterm infants reportedly have a lower incidence of nosocomial infection. Furthermore, exclusive breastfeeding offers some protection for infants with atopic predispositions.

Particularly critical for our most vulnerable ELBW infants, expressed breast milk (EBM) is better tolerated by the immature gut. Breast milk has a low osmolarity and results in faster gastric emptying than either diluted or concentrated formulas. Breast milk also contains growth factors and hormones, which may accelerate gut maturity, and anti-inflammatory factors, IL-10 and PAF-acetylhydrolase. Breast milk feeds promote gut colonization with benign fecal flora (lactobacillus) rather than potentially pathogenic Gram-negative rods. Premature infants being fed EBM are able to tolerate larger feeding volumes sooner and have a lower incidence of NEC.

There is credible evidence in the literature that breastfed term and preterm infants may have better neurodevelopmental outcomes at school age.

And, of course, the psychosocial benefits of breastfeeding are obvious. Breast-feeding facilitates bonding between mother and infant. Even in the extremely preterm infant who can only be gavage-fed EBM, pumping breast milk for her infant enables a mother to perform an exclusive function in the care of her baby. This ability often empowers mothers at a time when all of the rest of their infant’s care is performed by others in the highly technical and intimidating environment of the NICU.

References:

AAP. Breastfeeding and the use of human milk. Pediatrics 1997; 100: 1035-39.

Schanler RJ, et al. The use of human milk and breastfeeding in premature infants. Clin Perinatology 1999; 26 (2): 379-398.

Lucas A, Cole TJ. Breast milk and neonatal necrotizing enterocolitis. Lancet 1990; 336: 1519-23.

Lucas A, et al. Breast milk and subsequent intelligence quotient in children born preterm. Lancet 1992; 339: 261-4.

McGuire W, Anthony MY. Formula milk versus preterm human milk for feeding preterm or low birth weight infants. Cochrane Database of Systematic Reviews.   http://www.nichd.nih.gov/cochrane/McGuire/McGuire.htm