A newborn baby with a pipe through his nose being kangaroo kept by its mother

Human contact and breastmilk vital for premature babies

November is World Prematurity Awareness Month, with the 17th marked as World Prematurity Day. This year’s theme is BIG IMPACT – immediate skin-on-skin care for every baby everywhere.

Globally, approximately 10 million babies are born prematurely each year, with 86 000 premature births recorded in South Africa. Around 10% of these babies die within the first 24 to 48 hours. Prematurity has both short-term and life-long consequences for the infant with a high risk of mortality, as well as long morbidity.

Childbirth is a warrior’s journey for every mother, and a hero’s return as family and community celebrate the wonder of bringing new life into the world.

“It is one of the hardest times in a parent’s life. This is especially true for premature births, where parents are unexpectedly thrust into the trial of lengthy hospital stays and complications of prematurity that often leave them empty-handed and grieving. This is a traumatic time for the infant, too,” says Stasha Jordan, executive director of the South African Breastmilk Reserve (SABR).

Skin-on-skin and kangaroo care – where mothers and fathers wear their babies on the naked chest – supports the regulation of the baby’s temperature, aids in the production of surfactant to breathe, and offers the newborn readily available breastmilk and the comfort born from proximity to mom and dad.

Skin-on-skin practices also support healthy maternal lactation; therefore, it is key that the mother and newborn are not separated.

“It is essential for hospital facilities to allow for lodger facilities for the mothers of the babies admitted to the NICU, as this promotes lactation and kangaroo mother care,” says Jordan.

“It is crucial in the South African context to support all mothers to breastfeed – and in the context of prematurity, where hand expression and the use of breast pump replaces latching, specialised support is often needed to lactate. 

“Supporting lactation early in the life cycle has far-reaching consequences. Following discharge, many infants return to living environments where potable water and electricity are not readily available, and as beneficiaries of SASSA grants that are insufficient for the purchase of costly artificial feeds (formula). Breastfeeding is not an option for many of our communities – it’s a must,” she adds.

Health complications are often costly, impacting the public health budget as well as parents. These include respiratory distress syndrome, necrotising enterocolitis, bronchopulmonary dysplasia, intraventricular haemorrhage, sepsis, feeding difficulties, and auditory and visual difficulties. 

Premature births are preventable in most cases when expectant mothers access antenatal care, or what is known as the BANC+ system, which provides for eight visits throughout the pregnancy. Ongoing monitoring allows for the early detection of high-risk pregnancies while supporting mothers living with HIV.

30% of the new mothers in South Africa are HIV-positive and adhere to treatment. Treatment adherence is key to preventing the vertical transmission of the HI virus from mother to child. 

Some premature births are inevitable, and pregnant women need to be prepared for the possibility of giving birth early. In extreme cases, women give birth as early as 24 weeks of gestation, as opposed to a normal 40-week gestation pregnancy. 

Extremely low birth weight infants are born weighing as little as 400g and require life support and an extended NICU stay. Mothers who deliver a premature birth need support to manually express breastmilk until the baby can latch at the breast, and this varies depending on the complications of prematurity. Babies have been known to latch at 900g.

Expressed mother’s milk plays a key role in saving the lives of the most vulnerable premature patients, to achieve latching to the breast as soon as possible. According to the World Health Organization, all babies should receive exclusive breastfeeding for the first six months of life and with complementary feeding up to 24 months.

“Breastmilk offers unparalleled immunological protection at the beginning of the lifecycle; it is the first vaccine by nature,” says Jordan.

Donated breastmilk supplied by not-for-profit human milk banks like the SABR, Milk Matters, Netcare Ncelisa Human Milk Banks and other provincial initiatives by the Departments of Health provide lifesaving donated breastmilk – a lifeline for premature babies whose mothers are themselves hospitalised, unconscious or demised.

South Africa displays a unique co-operative structure of human milk banks under the policy leadership of the Department of Health, as well as a large investment in ensuring donated breastmilk is freely available within guidelines and prescription to premature babies in need in the NICU of public hospitals.

Supporting mothers to breastfeed in South Africa is a poverty alleviation strategy for the numerous families living below the poverty line and lacking water and electricity. Recent research points to early initiation of lactation as one of the key health indicators preventing later-stage malnutrition in babies and toddlers under 5 (Grow Great, 2022).

At the health systems level, capacitating postnatal wards with enough nursing staff and healthcare professionals with breastfeeding training is essential to successfully deliver universal healthcare and state-of-the-art medicine but, most importantly, to deliver human milk to human babies through an ever-evolving and growing global breastfeeding culture.

Join us this World Prematurity Day by supporting mothers to breastfeed and by wearing your baby skin-to-skin. Breastfeeding and wearing your baby on your chest provides much more than life support. Breastfeeding and skin-to-skin are love languages that support healthy early childhood development – an essential component for the healthy development of the parental bond.

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