special article by Misty D Virmani , MD ; Elizabeth W . Kim , MD
Division of Pediatrics , University of Arkansas for Medicla Sciences , Little Rock , Ark .
Mother ’ s Own Milk is Critical to the Health of Preterm Infants
Breast milk is accepted as the normal nutrition for newborns with continued benefits into their second and third years of life . Breast-milk feeding is important for both infant and maternal health . For the breast-fed infant , there is a decreased risk of sudden infant death syndrome ( SIDS ), childhood leukemia and lymphoma , severe asthma , and GI diseases . The breastfeeding mother experiences substantive benefits such as decreased risk of coronary artery disease , stroke , ovarian and breast cancers , and decreased risk of Type 2 diabetes . Despite knowing this information , many mothers still choose formula feeding . This decision has many competing interests for mothers : time , convenience , insecurities , and lack of social and medical support for breastfeeding . As health care providers , we can change how we support and encourage breastfeeding mothers . The way we talk about breastfeeding in the community and to our patients can shift the focus to how Arkansas can better support breastfeeding – because supporting breastfeeding benefits everyone .
Not only is breast milk beneficial for fullterm infants but also avoiding bovine derived formula is important , particularly for premature infants . Premature infants lack the benefit of time in the mother ’ s womb to accomplish very important developmental objectives , especially development of the fetal intestines . After birth , the infant ’ s gut mucosa is the site of a multitude of environmental exposures . The premature intestine is poorly adapted and tends toward pro-inflammatory responses with higher risk for invasion by enteropathogenic organisms . Research demonstrates that in premature infant intestinal epithelial cells , early exposure to bovine or soy-derived formulas causes extensive injury leading to cytotoxic responses and cell death . Similar exposure to breast milk had no such effect and was even found to reverse cellular damage . Formula exposure also increases the risk of necrotizing enterocolitis , a complication that at its most benign causes longer hospitalization and at its worse leads to death . It is critical that premature infants receive human milk as their only source of nutrition during this important period of gut and immune development .
The initial choice of feeding profoundly impacts the premature infant ’ s long-term outcome . Colostrum provides passive immune protection , helps the newborn ’ s immune system develop non-inflammatory responses to antigens , and protects the infant from pathogenic-invasive organisms . When newborns are fed foods other than mother ’ s colostrum and milk , the development of these intrinsic defense systems is altered , increasing life-long risk of allergic phenotypes , pro-inflammatory responses , and immune dysfunction .
One may ask if donor breast milk has similar benefits for an infant ’ s health . Donor milk holds an important place in the care of premature or sick infants when mother ’ s milk is unavailable , but it does not provide the essential benefits of mother ’ s own milk . Donor milk is most often obtained from mothers of term infants , most frequently beyond the first two months post-partum . Term breast milk is different from premature breast milk in many ways . The most important differences are the presence of immunoprotective enzymes , growth factors , bioactive proteins , and immunoglobulins , which are present in large quantities in the milk of a mother that delivers prematurely . The milk of a term mother in later stages of lactation contains less than one-eighth of the original concentration of protective components in her milk . Further , donor milk is processed by pasteurization and is then frozen . Pasteurization , while necessary , denatures many of the bioactive proteins that are so important in protecting a newborn . These processes , along with repeated freeze-thaw cycles , further diminish immunoprotective capacity of donor human milk to miniscule proportions . In the end , the benefit associated with donor milk is the ability to provide nutrition for growth without the harmful effects of providing bovine-derived formula .
Health care providers can fill a critical gap in the care of Arkansas ’ s most vulnerable citizens by encouraging and helping mothers provide breastmilk for their babies . Supporting early breastfeeding efforts and providing continued support of breastfeeding mothers after they leave the hospital provides substantial benefits in decreased infant and maternal mortality . For those mothers who deliver prematurely , it is of the utmost importance that we support their efforts to provide their own milk to their infants . This must become a public health priority in Arkansas . Each 1ml / kg / day of mother ’ s milk feedings in the first 14 days of life has an associated cost saving of $ 534 . At present , the cost of one-gram gold is approximately $ 65 . Indeed , each drop of a mother ’ s own milk is quite literally worth more than gold .
For more breastfeeding and neonatal care resources , visit ANGELS Guidelines at angelsguidelines . org .
For a complete list of references , email ams @ arkmed . org .
268 • The Journal of the Arkansas Medical Society www . ArkMed . org