Topic Outline
Topic Outline
Topic Outline


For newborns who are admitted to the neonatal intensive care unit (NICU), for prematurity or illness, breastfeeding is more challenging1,2. The maternal-infant separation is a barrier to establishing mother’s milk supply, and the infants often don’t have the opportunity for early feedings at the breast. Mother should be instructed to express milk by hand AND with a quality breast pump within 2 hours after birth, and regularly at least every 3 hours with no more than a 5-hour break at night. A typical pump session lasts 10-15 minutes. Mothers should have a consultation with a lactation specialist regarding proper use of her breast pump, including proper shield size, ideal pressures, duration of pumping, and addition of massage and manual expression. The addition of manual expression to pumping has been shown to increase milk volume and fat in the milk3. Pumping at the infant’s bedside and covering the collection bottles with a blanket while pumping might yield higher milk volumes.

It is optimal to establish an abundant milk supply during the first seven to ten days, which is approximately 600-625 ml/day4. The single most important factor for mothers who will be breastfeeding a preterm infant at home is maintaining a milk supply that exceeds the infant’s requirements at discharge4.

Although this is a time-intensive routine, it empowers the mom at a time when parents may feel at a loss of how else to help their infant(s).

Skin-to-skin is of great benefit for the mother’s mental health, her milk supply, and for infant’s cardiorespiratory and neuro-sensory regulation.




  1. Wight N, Kim J, Rhine W, Mayer O, Morris M, Sey R, Nisbet C. 2018. Nutritional Support of the Very Low Birth Weight (VLBW) Infant: A Quality Improvement Toolkit. Stanford, CA: California Perinatal Quality Care Collaborative Wilerson, AK, Uhde TW. Perinatal Sleep Problems Obstet Gynecol Clin N Amer 45 (2018) 483-494
  2. Hill PD, Aldag JC, Chatterton RT, Zinaman M Comparison of Milk Output Between Mothers of Preterm and Term Infants: The First 6 Weeks After Birth J Hum Lact 21(1) 22-30
  3. Morton J, Wong RJ, Hall JY, et al. Combining hand techniques with electric pumping increases the caloric content of milk in mothers with preterm infants. J Perinatol. 2012;32(10):791-796.
  4. Meier PP, Engstrom JL, Patel AL, et al Improving the Use of Human Milk During and After the NICU Stay Clin Perinatol 2010 Mar: 37(1) 217-245