Value of breast milk and breast milk substitutes for premature infants

This article provides a comprehensive review of the value of breast milk and breast milk substitutes for preterm infants and outlines an evidence-based strategy for the introduction of breast milk substitutes when necessary. Topics covered include indications for using substitutes, selection of appropriate formula types, ongoing monitoring of the infant’s nutritional and growth status, and transitioning to standard formulas or breast milk as the infant matures. The article also emphasises the importance of parental education and support throughout the feeding process. By adopting a structured approach, health professionals can ensure optimal growth and developmental outcomes in cases where breast milk is not available.

Professor Rajeev Gupta
Consultant Paediatrician, Barnsley Hospital; Chairman CSAC and Vice Chairman CESR Committee, Royal College of Paediatrics and Child Health; Professor (Institute of Medicine), University of Bolton, Barnsley
@rajeev20111

Gupta R. Value of breast milk and breast milk substitutes for premature infants. Infant 2025; 21(4): 100-03.

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Keywords

formula; premature birth; breast milk; nutrition

Key points

Breast milk is widely considered the optimal source of nutrition for all infants, including preterm babies.
Breastfeeding preterm infants presents unique challenges.
When neither maternal breast milk nor donor milk is accessible, the use of breast milk substitutes becomes necessary.
The introduction of breast milk substitutes in premature infants must be handled with care, balancing the benefits of providing adequate nutrition with the need to minimise the risks associated with formula feeding.

Also published in Infant:

VOLUME 16/ISSUE 1, JANUARY 2020

Full milk feeding from day one for preterm infants

The FEED1 trial will investigate whether full milk feeds from day 1 in infants born at 30⁺⁰ to 32⁺⁶ weeks’ gestation reduces the length of hospital stay when compared to intravenous fluids or parenteral nutrition with gradual milk feeding. Early establishment of milk feeding in preterm infants could reduce risks of infection and improve growth. Achieving fully nutritional volumes of milk feeds earlier and improving growth without infections or necrotising enterocolitis may help the infant to be ready for home sooner.