World Prematurity Day, commemorated on 17 November, celebrates the lives of premature babies and aims to raise awareness of the condition.

"Every year an estimated 15 million babies are born too early – that equates to more than one in every 10 babies!" says Dr Evette van Niekerk, a researcher from the Division of Human Nutrition at the Faculty of Medicine and Health Sciences, Stellenbosch University.

Premature infants are born before 34 weeks of gestation and death rates are high among these infants due to complications. Many that survive face a lifetime of disability, including learning disabilities and visual and hearing problems. Van Niekerk explains that premature babies are particularly vulnerable in resource-limited settings and developing countries due to a lack of feasible, cost-effective care, such as warmth, breastfeeding support, and basic care for medical and respiratory complications.

"Nutritional support plays a fundamental role in the survival of the premature infant. However, due to the incomplete development of the intestinal function, many of these babies cannot tolerate full enteral feeding," says Van Niekerk. (Enteral feeding refers to the delivery of nutritionally complete food directly into the stomach).

Preterm infants have higher nutritional requirements compared to babies born at full-term. In order to achieve "normal" growth rates and optimise neurodevelopmental and long-term health outcomes, preterm babies should ideally receive the same nutritional supply as they would have had intrauterine.

Unfortunately, worldwide data indicate that typical growth rates for preterm infants lag behind the normal foetal growth rate, especially for those born at the earliest gestational ages and those with the lowest birth weights. The most common reasons for growth restrictions after birth are inadequate nutrition, feeding intolerance, and critical illness.

"Breastmilk is widely recognised as the optimal food for both full-term and preterm infants. The numerous advantages of breastmilk include the earlier achievement of full enteral feeding, the presence of active enzymes which enhance the maturation of the immature gut, and anti-infective agents which protect the newborn from infections. The use of breastmilk should be strongly advocated in neonatal units," says Van Niekerk.

Breast milk also contains complex milk starches, called human milk oligosaccharides (HMO), which has shown to reduce the risk of a serious condition, called necrotising enterocolitis (NEC), that commonly occurs in preterm infants.

"Breastfeeding practices after birth in resource-limited settings and developing countries such as South Africa can be supported by practising kangaroo mother care in neonatal units.  Kangaroo mother care is a technique practiced on newborns that entails the infant being held skin-to-skin with an adult. It has numerous health benefits for mother and child, including improved body measurements, better breastfeeding, and mother satisfaction, among others," says Van Niekerk.

She concludes with the words of Vassilios Fanos: "Human milk is capable of preventing many diseases. The first moments of life are important for the destiny of an individual: normally this is recognised for the lungs and the first breath, but it is also true for the other organs, in particular for the intestine ('the first meal is like the first breath')."¹

1. Fanos V. Metabolomics, milk-oriented microbiota (MOM) and multipotent stem cells: the future of research on breast milk. Journal of Pediatric and Neonatal Individualized Medicine. 2015 Mar 2;4(1):e040115.