Premature Infants: Our Story and How Tiny Microbiomes Make a Big Difference
Little did I know, as many as 15 million preterm births take place worldwide each year. Thanks to advancements in technology and medicine, the majority of these preterm babies not only survive but also go on to thrive as healthy, happy individuals.
There are many reasons why an infant can be born before 37 weeks (when a growing baby is considered to be full-term); some are preventable while others are not. We can take every precaution when it comes to having a healthy pregnancy, but emergencies do happen and, as I found out the hard way, not everything is avoidable.
Each year, March of Dimes designates November as World Prematurity Awareness Month and encourages recognition and conversation about preterm birth with World Prematurity Awareness Day. They’ve even set up a Facebook page with an interactive map of inspiring, beautiful stories of premature births from around the world.
You see, this is an issue that affects every country and touches many lives, but most are unaware of it unless one dreaded day they find themselves smack in middle of the alter-reality called the NICU, as was the case with our family. It was only 4.5 months ago that my son entered the world and brought us abruptly up to speed on the realities of premature arrivals. That’s why this year, to participate in November’s prematurity awareness movement, we’ve rounded up some of the top ways to help support the health of premature infants starting at the microbial level.
Introducing the Human Microbiome
Have you heard of the human microbiome? Believe it or not, our bodies are comprised of trillions of bacteria that colonize to make up our bodily functions and keep us healthy. The vast majority of these bacteria are located in the gut, which is why we often hear about bacteria and gut health being related. And the science is clear: gut health begins at birth.
While you’re filled with trillions of floating friends who help support your digestion, mood, immune system, and have many other functions as well, your tiny infant likely has little bacteria until birth (though new research is uncovering more about the infant inoculation all the time). As your baby passes through the vaginal canal, is embraced in skin-to-skin contact and enjoys his first foods, he immediately inherits his most important gift from his mom: bacteria.
When born prematurely, the mode of delivery, environmental factors, and the consecutive weeks in the hospital or NICU can disrupt the development of your child’s microbiome—which can have potential health consequences later in life.
As a preterm baby’s gut strives to acquire the bacteria needed to colonize the gastrointestinal tract and build the immune system, he or she may be simultaneously given heavy doses of life-saving antibiotics to prevent infection and may need to be separated from his parents and other sources of healthy bacteria.
Findings from an August 2015 survey in PNAS of 922 fecal samples collected from 58 preterm infants show that these interventions can have a devastating effect on a fragile microbiome, making it hard for the good bacteria to colonize and maintain the body’s microbial balance during this critical time of life.1
So what can you do to counter these less than ideal start-up conditions and nurture your child’s microbiome? Here are my tips:
Stay in Contact With Your Baby
Though many preemies require medical intervention such as a C-PAP (Continuous Positive Airway Pressure) to help them breathe or an oral or nasal feeding tube, it is critical that your child get as much of your good bacteria as possible, and they can receive this bacteria through your skin after they’re born.
Despite being hooked up to tubes and monitors, it’s often still possible to engage in what Columbian doctors coined in 1983 as “Kangaroo Care.” Kangaroo care is where parents hold their newborn children upright and to their chest as often as possible—which can be from 60 minutes to 24 hours a day. While helpful even for full-term babies, Kangaroo Care has been shown to have many benefits for premature infants that include regulated body temperature, an increase in immune health and weight gain, a higher rate of breastfeeding success, and even healthier heart rates as published in a 1998 study by Gay Gale and Kathleen Vandenburg.2
For this reason, talk with your doctors about having as much skin-to-skin contact with your preterm baby possible. The great news is that many hospitals around the country are now recognizing this research and are advocates—encouraging as much skin-to-skin contact as the parents are able to give.
If you have other little ones at home, this can be especially difficult but it is important nonetheless. After all, your wee one is still meant to be in the womb.
Breastfeed With All Your Might
It typically takes a day or two (sometimes longer) after birth for a mother’s milk to fully come in; however, if your baby is born months before they’re expected, factors like emotional stress, fatigue and discomfort can affect the milk supply and leave new mothers feeling frustrated and down—a common reason why many women turn to supplementing with instant formula shortly after giving birth.
While it can be easy to get discouraged during these first few days of postpartum life when only small droplets of milk may be available, it’s important to keep in mind that even these tiny droplets are truly nature’s medicine for your baby’s growing immune system. In a 2015 study published in Science Magazine, researchers Katie Hinde and Zachary T. Lewis found that breast milk is filled with hundreds of beneficial bacteria that get to work colonizing your baby’s individual gut flora which will become the foundation for his or her immune function (80% of immune system cells reside in the GI tract).3 Check out their detailed infographic of how breast milk helps shapes the infant microbiome.
Many experts recommend hand-expressing breast milk within the first few hours after birth to activate your milk ducts for a healthy supply. When the risk of having a preterm baby became apparent in our lives, a friend gave me advice that may have made all of the difference in our breastfeeding efforts: she said, “No matter what, start hand-expressing within an hour or two after the birth to tell your body to make milk.”
And that’s what we did.
Determined, my husband and I would sit for 45-60 minutes each session while I hand-expressed tiny drops of colostrum and he collected it with a syringe. Those first few days before my milk came in were intense but the reward was liquid gold (literally) for our bundle of joy!
Once your milk comes in, you can move to a breast pump if your newborn is still not able to suckle—and life gets a bit easier. Also, keep in mind that pumping frequency (every 2-3 hours from start-to-start) is the most important factor for producing enough milk. This can be particularly challenging when you are simultaneously dealing with the stress and unknowns of having an early baby, commuting to and from the hospital, healing from the birth, etc. but it is incredibly important if breastfeeding is your goal.
Research connecting the importance of breast milk with infant health is so evident that many NICUs will even recommend donor milk in the case that your supply is low. Most hospitals also have on-site lactation consultants that can help determine the best fit for your needs, so be sure to reach out to the resources available to help give your child the best, all natural first foods.
As a side note and hopefully a touch of encouragement, I’d like to report that - after our 64 day NICU stay and a lot of blood, sweat, *milk* and tears—today we are exclusively breastfeeding. And I’m talking at the breast. No tubes, no bottles, not even any pumping. It was a long journey and we took the scenic route, but we eventually arrived.
Make Your Personal Health a Priority
The NICU days and weeks can be an emotional rollercoaster and leave you feeling depleted in every way. And while greasy, unhealthy meal choices might be tempting to alleviate some of the tension or simply because they are more convenient, remembering to care for your health is one of the most important things you can do for your preemie.
Recovering from a preterm delivery can often mean that you’re recovering from major abdominal surgery, which might not make you feel like doing much for your physical well-being. But it’s true that a happy, healthy baby starts with supported, healthy parents.
During our NICU stay, we knew that my nutrition had never been more important—yet we lacked both the time and energy to source and prepare food. Luckily, we found a healthy meal delivery service that served organic, balanced meals. Premature babies often don’t have the necessary iron stores and may be deficient in other vitamins and minerals as they begin their early life on earth, so do your best to get plenty of nutrients like iron, protein, folate and calcium. The more natural vitamins and minerals you can get, the better you’ll feel and the more you’ll be able to benefit and nurture your baby.
In addition to the foods you eat, there are many supplements that can make it easier for your body to keep getting the vitamins that both you and your child need. And one of the most important supplements is probiotics. Probiotics can help support nutrient absorption, but they also pass through your breast milk, and can help care for your little one’s system, giving him a head start on health now and as he grows.
Many hospitals in Japan have begun to administer probiotics directly to premature infants. I personally was not as comfortable with this, knowing just how fragile a preterm baby can be. Instead, I made sure my system remained adequately populated with beneficial bacteria by taking probiotic supplements and eating prebiotic foods so that I could pass the good flora on to my babe through my milk.
Fortunately, our PRO-Moms formula was designed for pregnant and nursing mothers, with 5 billion colony forming units in time-release tablets so the good stuff can actually make it to your gut. Plus, it has kiwifruit powder, which is considered a superfood that acts as a prebiotic (by feeding the probiotics) and supports your digestive function. From personal experience, it’s a targeted formula with ideal strains for mom and baby and I can’t recommend it enough! There is simply nothing like knowing that you are providing your newborn with the best nourishment available.
Prematurity is never planned but prioritizing optimal gut health in the midst of it all is full-on strategic. As research on the microbiome and how it relates to our overall health continues to grow, one thing is clear—going above and beyond to nurture your little one’s gut is one of the most important things you can do to encourage their wellness from day one and as they begin to grow and discover the world around them.
Today, our family is fortunate enough to have a happy, healthy (and chunky) baby boy. And we learned a lot—like how much it is possible to love another human being. We’d love to hear from you. How has premature birth affected your life and what steps did you take to maintain your (or your newborn’s) health?
1. Rosa, P. S., Warner, B. B., Zhou, Y., Weinstock, G. M., Sodergren, E., Hall-Moore, C. M., . . . Tarr, P. I. (2014). Patterned progression of bacterial populations in the premature infant gut. Proceedings of the National Academy of Sciences,111(34), 12522-12527.
2. Gale, G., VandenBerg, K.A., (1998). Kangaroo Care. Neonatal Network, 17(5), 69-71.
3. Hinde, K., & Lewis, Z. T. (2015). Mother's littlest helpers. Science,348(6242), 1427-1428.
Written by Jamie Morea, Gut Health Evangelist, Mama Bird & Co-founder of Hyperbiotics. For more ideas on how you can maximize wellness and benefit from the power of probiotics, be sure to subscribe to our newsletter.