Preterm & Unwell Infants

by Dr Louise Santhanam, General Practitoner

Breastfeeding has been of huge benefit to my son, who has a congenital heart defect. It has protected him from infection, provided him with pain relief after surgeries and provided him with enormous comfort and reassurance. It raises his oxygen saturations1 and helps him to maintain his temperature. It is a tragedy that so few children with his condition (Hypoplastic Left Heart Syndrome, HLHS) are currently supported to breastfeed.

H, Mother

Neonatal Intensive Care

The experience of a preterm or unwell neonate on the neonatal intensive care unit is complex and can be extremely stressful for both the infant and the whole family.  Even a short, medically ‘uneventful’ stay can be highly stressful and may have the effect of leaving the parents with a heightened concern for their baby’s health.

Having been in a high-intensity medical environment often for multiple weeks, continuity of care upon discharge with effective communication to the GP and preparation for the family to cope at home is important. Families typically move very quickly from medical management to being at home as sole carers and often at a stage when direct breastfeeding is just beginning, which can be overwhelming.

Significant considerations for the transition to home from NICU regarding infant feeding and developing secure infant attachment include:

  • When breastfed or expressed breastmilk fed babies are discharged home it is important that parents are made aware of community breastfeeding support services and encouraged to seek ongoing support if needed, especially if a baby is discharged before effective breastfeeding is fully established.
  • Mothers and babies may have been feeding at the breast for a very short period only and may also be expressing and topping up with breastmilk, measuring and documenting everything as instructed on the NICU.  This feeding scenario is a complex one and requires ongoing support to ensure a smooth transition to full direct breastfeeding and also to assist with the transition to parenting a well baby.
  • If infants are discharged on specialist formula the GP can be supported by clear instructions on the quantities needed and on when to review or switch to other milks.
  • Parents of infants hospitalised in the NICU are at high risk for experiencing a mental health problem in the first postnatal year, including postpartum depression and PTSD (estimated at 20-30% of parents or higher2). Sensitive questioning at any postnatal encounter can help to identify when parents require support and treatment.  Familiarity with how to refer or signpost to local perinatal mental health services, health visiting and parent support services is important.  See also our page on ‘Maternal Mental Health‘.

See also our webpages:

Expressed Breastmilk Feeding

Breastmilk Donation

Galactagogues Information about prescribing galactagogues which may be requested for mothers of preterm babies in the SCBU or NICU.

Infant Milks and Bottle Feeding

Twins & Multiples

‘First Feed’ from the collection ‘Breastfeed’, with thanks to the Artist: Leanne Pearce

Preterm Infants 

NHS Website: Breastfeeding Your Premature Baby

Bliss for Babies Born Premature or Sick: Feeding Information on the variety of methods that may be used to feed preterm and unwell babies admitted to the SCBU or NICU.

Bliss for Babies Born Premature or Sick: Weaning Information on introducing complementary foods to preterm infants.

RCPCH: UK-WHO Growth Charts – Guidance for Health Professionals Includes information on plotting preterm infants.

UK Drugs in Lactation Advisory Service (UKDILAS) Provided by UKMi (part of the NHS Specialist Pharmacy Service) supporting safe use of medicines during breastfeeding. UKDILAS can offer advice on prescribing for mothers breastfeeding preterm infants as part of their enquiry answering service.

Specialised Infant Milks

First Steps Nutrition Trust: Specialised Infant Milks in the UK (Infants 0-6 months) Information for Health Professionals Includes information on supporting mothers to breastfeed, human donor milk, appropriate prescribing of specialised milks and making up specialised milk feeds.

Further Information on Neonatal Care

Unicef UK Baby Friendly Initiative: You and your baby- Supporting love and nurture on the neonatal unit Leaflet for parents.

Unicef UK Baby Friendly Initiative: Neonatal Unit Guidance- Implementing the Standards Standards to support neonatal units to become Baby Friendly. The standards cover Staff education, helping parents to develop close and loving relationships with their infant(s), enabling babies to receive breastmilk and breastfeed when possible and valuing parents as partners in care. Preparation for discharge and information about how to access support with feeding in the community is highlighted.

Bliss: What is the Bliss Baby Charter? Bliss has developed best practice standards for neonatal units to facilitate the provision of high quality family-centred care. Principle 6 refers to the active promotion of breastmilk expression and breastfeeding and ensuring healthcare professionals are equipped with the knowledge and skills to support lactation after preterm birth. Principle 7 refers to ensuring continuity of care at discharge home.

Unwell Infants and Children

KellyMom: My Baby is Sick- Should I Continue to Breastfeed? Includes information on colds and nasal congestion, diarrhoea and vomiting and feeding refusal.

NHS Website: Diarrhoea and Vomiting in Babies and Children Includes guidance on rehydration for breast and bottle fed babies. Stresses that formula feeding can be supplemented with additional water but bottles of formula should always be made up appropriately and not watered down in these circumstances.


  1. Marino B, O’Brien P, LoRe H. Oxygen saturations during breast and bottle feedings in infants with congenital heart disease. Journal of Pediatric Nursing. 1995;10(6):360-364
  2. Hynan M, Steinberg Z, Baker L et al. Recommendations for mental health professionals in the NICU. Journal of Perinatology. 2015; 35, S14–S18

Published April 2017, Updated September 30th 2019