Welcome to professional know-how
Get practical videos and helpsheets on pregnancy and baby care, plus all the personalized know-how you need
You already have an account?
or Register now
Forgot your password?

Benefits of breast milk

Information on the benefits of breast milk for preterm babies

Benefits of breastfeeding

  • Breast milk is the best source of nutrition for preterm infants because it offers nutritional1, immunological2, gastrointestinal3, physiological4 and developmental5 benefits.  Research has shown that feeding breast milk may have an impact on a preterm infant’s long term health and development
  • Breast milk is a dynamic fluid that changes composition over the period that it is being fed.  Foremilk, which i s at the beginning of the feed, is lower in energy and fat and higher in carbohydrate6,7.  Hindmilk is at the end of a feed: it is higher in energy and fat and lower in carbohydrate6.  These changes allow for meeting the needs of an infant

Protein

  • Preterm breast milk is whey dominant; whey proteins are more appropriate for preterm infants as they are very easily digested and whey promotes a rapid gastric emptying7
  • Whey protein in breast milk also contains non-nutritional factors that have a role in the immune system of the preterm infant.  Whey protein contains secretory Immunoglobulin A (sIgA), which is thought to be linked to the lower incidence of necrotising enterocolitis (NEC) (inflammation and necrosis of the gut)8
  • Whey protein also contains lysozmes and lactoferrin, which influence the host defence of the preterm infant9

Fat

  • The fat composition of breast milk provides 50% of the calories for a preterm infant which is used for energy; it also provides the essential polyunsaturated fatty acids and lipid soluble vitamins10
  • In animal studies, a lower incidence of NEC is also thought to be linked with the high levels of polyunsaturated fatty acids found in breast milk11
  • Breast milk also contains bile salt-stimulated lipase to help break down the fat and help aid absorption12
  • Breast milk contains long-chain polyunsaturated fatty acids (LCPs) that are associated with improved cognitive development, visual acuity and eicosanoid formation
  • Cognitive development: The brain undergoes rapid growth in the third trimester of pregnancy.  LCPs are involved in brain development, in particular the formation of new neural cells.  They are transferred from the maternal circulation to the placenta, to the foetal liver, and finally to the foetal brain.  The brain and central nervous system are involved in transmitting nerve impulse signals throughout the body, through the nerve fibres, enabling the infant (and adults) to co-ordinate and learn13,14
  • A meta-analysis of 20 studies has indicated that low birthweight infants had greater benefits in cognitive development from being fed breast milk compared to a formula-fed group15
  • Visual acuity: The eyes also actively accumulate LCPs, especially Docosahexaenoic acid (DHA), which are required for the formation of new neural cells. Neural cells form nerves, which are responsible for the transmission of nerve impulses between the brain and eyes16,17
  • The retina of the eye is sensitive to light and it sends messages to the brain. Hence the retina requires a very high concentration of DHA, as this is important to form the large number of neural cells required in the role of vision (which is often tested as visual acuity)
  • Eicosanoids: LCPs, in particular arachidonic acid (AA), are important for the formation of eicosanoids18.  Eicosanoids are a group of substances that include prostaglandins, thromboxanes, leukotrienes and lipoxins, each with differing functions, e.g. prostaglandins make blood vessels relax or constrict19

Carbohydrate

  • The main carbohydrate in breast milk is lactose.  Lactose is important as it has been shown to help with improving the absorption of certain minerals20,21, in particular calcium, which is essential for bone mineralisation in preterm infants22 to help achieve the catch-up growth they require
  • Research has shown that lactose that is not absorbed by the preterm/low birthweight infant increases the beneficial bacteria in the gut, thus helping to develop the intestinal flora 20,21,23

Gastrointestinal benefits

  • The gastric emptying of breast milk is faster than formula milk as the nutrients are in the optimum format for absorption
  • Breast milk is also thought to help with gastrointestinal maturation. This is thought to be due to the hormones, peptides, epidermal and nerve growth factor, glutamine, cortisol, amino acids and glycoproteins that are all found in breast milk24

Immunological benefits

  • Breast milk has many immunological benefits, including lactoferrin, secretory Immunoglobulin A (sIgA), lyzosomes and interferon 
  • Research has shown that preterm breast milk may help to protect against infections, including sepsis meningitis25,26 and it is also thought to help lower the incidence of necrotising enterocolitis (NEC), which causes inflammation of the gut and may lead to necrosis27,28
  • It is thought to be the sIgA that has a protective role in the gut lumen, which is thought to be associated with the lower incidence of NEC7
  • Specific nutrients that are abundant in breast milk, such as glutamine and nucleotides, which may be beneficial to gastrointestinal cell metabolism and function and improve the infant’s ability to tolerate enteral feeds helping to reduce the risk of NEC29.  Growth factors and hormones in breast milk may also directly improve gastrointestinal function and maturity, and may also have a role in reducing the risk of NEC30, but further research is required in this area

Benefits for the mother

  • Breastfeeding has been shown to help reduce the risk of postpartum blood loss by increasing the rate of uterine contraction. Because of this, breastfeeding is thought to help reduce the risk of postpartum haemorrhages31,32 and help to bring the uterus back to its original size
  • Breastfeeding is linked with an improved sense of self-esteem and success with mothering31

  • There is also evidence to show that breastfeeding can help to reduce the mother’s risk of pre-menopausal breast cancer and ovarian cancer 31

References
  1. Cavell B.  Gastric emptying in infants fed human milk or infant formula.  Acta Pediatr Scand 1981; 70: 639-641.
  2. Hylander M et al.  Human milk feedings and infections among very low birthweight infants.  Pediatrics 1998; 102: e38.
  3. Lucas A et al.  Breast milk and subsequent intelligence quotient in children born preterm.  Lancet 1992; 339: 261-264.
  4. Anderson J et al. Breastfeeding and cognitive development: a meta-analysis. Am J Clin Nutr 1999; 70 (4): 525-535.
  5. Valentine C et al.  Hind milk improves weight gain in low-birth-weight infants fed human milk.  JPGN 1994; 18: 474-477.
  6. Emery W et al.  Influence of sampling on fatty acid composition of human milk.  Am J Clin Nutr 1978; 31: 1127-30.
  7. Hall W et al.  Casein and whey exert different effects on plasma amino acid profiles, gastrointestinal hormone secretion and appetite.  Brit J Nutr 2003; 89: 239-48.
  8. Eibl M et al.  Prevention of necrotizing enterocolitis in low-birthweight infants by IgA-IgG feeding.  N Engl J Med 1988; 319:1-7.
  9. Jacobsson I et al.  Dietary bovine alpha-lactoglobulin is transferred to human milk.  Acta Paediatr Scand 1985; 74: 342-345.
  10. Tsang R et al.  Nutrition of the preterm infant: Scientific basis and practical guidelines. 2d Ed.  Cincinnati, OH: Digital Educational Publishing, Inc: 2005: 357-381.
  11. Caplan M et al.  Effect of polyunsaturated fatty acids (PUFA) supplementation on intestinal inflammation and necrotizing enterocolitis (NEC) in a neonatal rat model.  Pediatr Res 2001; 49: 647-652.
  12. Jensen R and Jensen G.  Speciality lipids for infant nutrition: Milks and formulas.  JPGN 1992; 30: 404-412
  13. Willatts P et al. Effect of long-chain polyunsaturated fatty acids in infant formula on problem solving at 10 months of age.  Lancet 1998;352(9129):688-91.
  14. Koletzko B et al. Long chain polyunsaturated fatty acids (LC-PUFA) and perinatal development. Acta Paediatr 2001;90:460-4.
  15. Anderson J et al.  Breastfeeding and cognitive development: a meta analysis.  Am J Clin Nutr 1999; 70: 525-535.
  16. Birch EE et al. Visual acuity and the essentiality of docosahexaenoic acid and arachidonic acid in the diet of term infants. Paediatr Res 1998;44(2):201–9.
  17. San Giovanni JP et al. Dietary essential fatty acids, long-chain polyunsaturated fatty acids, and visual resolution acuity in healthy full term infants: a systematic review. Early Hum Dev 2000;57(3):165–88.
  18. Fleith M, Clandinin MT.  Dietary PUFA for preterm and term infants: review of clinical studies.  Crit Rev Food Sci Nutr 2005; 45(3): 205-29.
  19. Uauy R et al.  Essential fatty acids as determinants of lipid requirements in infants, children and adults.  Eur J Clin Nutr 1999; 53 (suppl 1): S66-77
  20. Whyte R et al.  Faecal excretion of oligosaccharides and other carbohydrates in normal neonates.  Arch Dis Child 1978; 53: 913-915.
  21. Atkinson SA.  Human milk feeding of the micro-preemie.  Clin Perinatol 2000; 27: 235-247.
  22. Ryan S.  Bone mineralisation in preterm infants.   Nutrition 1998; 14: 745-747.
  23. Claud EC and Walker WA.  Hypothesis: inappropriate colonisation of the premature intestine can cause neonatal necrotising enterocolitis.  FASEB J 2001; 15: 1398-1403.
  24. Sheard N and Walker W.  The role of breast milk in the development of the gastrointestinal tract.  Nutr Rev 1988; 46: 1-8.
  25. Strodbeck F.  The role of early enteral nutrition in protecting premature infants from sepsis.  Crit Care Nurs Clin N Am 2003; 15(1): 79-87.
  26. Hylander M et al.  Human milk feedings and infection among very low birthweight infants.  Pediatrics 1988; 102: e38.
  27. Atkinson SA et al.  Human milk feeding in premature infants: protein, fat and carbohydrate balances in the first 2 weeks of life.  J Pediatr 1981; 99: 617-624.
  28. Lucas A and Cole TJ.  Breast milk and neonatal necrotising enterocolitis.  Lancet 1990; 336: 1519-1523.
  29. Heinig MJ and Dewey KG.  Health advantages of breastfeeding for infants: a critical review.  Nutr Res Rev 1996; 9: 89-110.
  30. Kliegman RM et al.  Necrotizing enterocolitis: research agenda for a disease of unknown etiology and pathogenesis. Pediatr Res 1993; 34: 701-708.
  31. Labbock MH.  Health sequelae of breastfeeding for the mother.  Clin Perinatol 1999; 26(2): 491-503.
  32. Leung A and Sauve R.  Breast is best for babies.  J Natl Med Assoc 2005; 97(7): 1010-9.
  1. Cavell B.  Gastric emptying in infants fed human milk or infant formula.  Acta Pediatr Scand 1981; 70: 639-641.
  2. Hylander M et al.  Human milk feedings and infections among very low birthweight infants.  Pediatrics 1998; 102: e38.
  3. Lucas A et al.  Breast milk and subsequent intelligence quotient in children born preterm.  Lancet 1992; 339: 261-264.
  4. Anderson J et al. Breastfeeding and cognitive development: a meta-analysis. Am J Clin Nutr 1999; 70 (4): 525-535.
  5. Valentine C et al.  Hind milk improves weight gain in low-birth-weight infants fed human milk.  JPGN 1994; 18: 474-477.
  6. Emery W et al.  Influence of sampling on fatty acid composition of human milk.  Am J Clin Nutr 1978; 31: 1127-30.
  7. Hall W et al.  Casein and whey exert different effects on plasma amino acid profiles, gastrointestinal hormone secretion and appetite.  Brit J Nutr 2003; 89: 239-48.
  8. Eibl M et al.  Prevention of necrotizing enterocolitis in low-birthweight infants by IgA-IgG feeding.  N Engl J Med 1988; 319:1-7.
  9. Jacobsson I et al.  Dietary bovine alpha-lactoglobulin is transferred to human milk.  Acta Paediatr Scand 1985; 74: 342-345.
  10. Tsang R et al.  Nutrition of the preterm infant: Scientific basis and practical guidelines. 2d Ed.  Cincinnati, OH: Digital Educational Publishing, Inc: 2005: 357-381.
  11. Caplan M et al.  Effect of polyunsaturated fatty acids (PUFA) supplementation on intestinal inflammation and necrotizing enterocolitis (NEC) in a neonatal rat model.  Pediatr Res 2001; 49: 647-652.
  12. Jensen R and Jensen G.  Speciality lipids for infant nutrition: Milks and formulas.  JPGN 1992; 30: 404-412
  13. Willatts P et al. Effect of long-chain polyunsaturated fatty acids in infant formula on problem solving at 10 months of age.  Lancet 1998;352(9129):688-91.
  14. Koletzko B et al. Long chain polyunsaturated fatty acids (LC-PUFA) and perinatal development. Acta Paediatr 2001;90:460-4.
  15. Anderson J et al.  Breastfeeding and cognitive development: a meta analysis.  Am J Clin Nutr 1999; 70: 525-535.
  16. Birch EE et al. Visual acuity and the essentiality of docosahexaenoic acid and arachidonic acid in the diet of term infants. Paediatr Res 1998;44(2):201–9.
  17. San Giovanni JP et al. Dietary essential fatty acids, long-chain polyunsaturated fatty acids, and visual resolution acuity in healthy full term infants: a systematic review. Early Hum Dev 2000;57(3):165–88.
  18. Fleith M, Clandinin MT.  Dietary PUFA for preterm and term infants: review of clinical studies.  Crit Rev Food Sci Nutr 2005; 45(3): 205-29.
  19. Uauy R et al.  Essential fatty acids as determinants of lipid requirements in infants, children and adults.  Eur J Clin Nutr 1999; 53 (suppl 1): S66-77
  20. Whyte R et al.  Faecal excretion of oligosaccharides and other carbohydrates in normal neonates.  Arch Dis Child 1978; 53: 913-915.
  21. Atkinson SA.  Human milk feeding of the micro-preemie.  Clin Perinatol 2000; 27: 235-247.
  22. Ryan S.  Bone mineralisation in preterm infants.   Nutrition 1998; 14: 745-747.
  23. Claud EC and Walker WA.  Hypothesis: inappropriate colonisation of the premature intestine can cause neonatal necrotising enterocolitis.  FASEB J 2001; 15: 1398-1403.
  24. Sheard N and Walker W.  The role of breast milk in the development of the gastrointestinal tract.  Nutr Rev 1988; 46: 1-8.
  25. Strodbeck F.  The role of early enteral nutrition in protecting premature infants from sepsis.  Crit Care Nurs Clin N Am 2003; 15(1): 79-87.
  26. Hylander M et al.  Human milk feedings and infection among very low birthweight infants.  Pediatrics 1988; 102: e38.
  27. Atkinson SA et al.  Human milk feeding in premature infants: protein, fat and carbohydrate balances in the first 2 weeks of life.  J Pediatr 1981; 99: 617-624.
  28. Lucas A and Cole TJ.  Breast milk and neonatal necrotising enterocolitis.  Lancet 1990; 336: 1519-1523.
  29. Heinig MJ and Dewey KG.  Health advantages of breastfeeding for infants: a critical review.  Nutr Res Rev 1996; 9: 89-110.
  30. Kliegman RM et al.  Necrotizing enterocolitis: research agenda for a disease of unknown etiology and pathogenesis. Pediatr Res 1993; 34: 701-708.
  31. Labbock MH.  Health sequelae of breastfeeding for the mother.  Clin Perinatol 1999; 26(2): 491-503.
  32. Leung A and Sauve R.  Breast is best for babies.  J Natl Med Assoc 2005; 97(7): 1010-9.

 Rate
Educational study days

The SMA Nutrition study day programmes are chaired and presented by leading healthcare professionals who are all experts in their fields.


They offer thought-provoking sessions designed to increase the knowledge and expertise of healthcare professionals, and to develop day-to-day professional skills.

Register now for regular updates
  • Unbranded helpsheets in 7 languages
  • Free downloadable literature and tools
  • Access to e-learning modules for professional development
  • Quarterly clinical updates
  • Be the first to hear about our educational study days

Register for free