Colostrum - Drops of Life
There remains no doubt among experts that colostrum, the first milk mothers produce when starting breastfeeding, is the ideal nourishment for a newborn. It's unique composition is tailored to the fragile infant's specific needs in the first hours and days of his life. Thick and distinctly more yellow1 in appearance compared to mature mother's milk, colostrum contains nutrients in highly concentrated form. It is full of protein, yet low in fat, making it easy to digest.2 Most importantly, it plays a crucial role in building the infant's fragile immune system and kick-starting baby's healthy development. So much in fact, that colostrum has sometimes been dubbed a baby's “first vaccination”.
A LITTLE GOES A LONG WAY
A little literally goes a long way with these droplets – and their scarcity make them all the more precious to save: post-partum, colostrum is typically only available to the infant in the first three to five days before the mother's milk develops into transitional and later mature milk3 – with one exception: Research has found that in mothers of preterms colostrum can, in fact, last longer. In light of the importance of the protective properties of colostrum for fragile infants in particular, this, of course, makes a lot of sense. Therefore, to ensure these infants can benefit from colostrum's unique ingredients as much as possible, it is crucial that they receive their mother's colostrum – regardless of the overall feeding situation and decision.4
“It is almost impossible to grasp how positive the effect of colostrum is on a sick child. The components are too many to list.”
Serena Debonnet, midwife, lactation consultant and BFHI coordinator, Belgium
- White blood cells that produce antibodies to neutralize bacteria and viruses.5 This is particularly relevant for infants with immature guts and can prevent diarrhoea.
- sIgA antibodies lining the infant's gastrointestinal tract.6 They become concentrated in the mucus lining of the gut and respiratory system, protecting the infant against illnesses the mother has already experienced.
- TGF-beta and Insulin-like growth factors, that stimulate growth of protective mucus membranes in the infant's intestines, assist with tissue repair after stress and can decrease intestinal cell apoptosis (cell death).7
- Prebiotics, such as human milk oligosaccharides (HMOs), in colostrum feed and build up the "good" bacteria in infants gut.8
- Vitamins protect and help your baby start fi ghting infections on his own. They can, for example, produce vitamin A, important for visual development.9
- Minerals, e.g. magnesium, copper and zinc. While magnesium supports the heart and bones, copper and zinc, help develop the infant's immune system.10,11 Zinc also aids brain development, and there's nearly four times more zinc in colostrum than in mature milk.
- Laxative properties help the infant have his fi rst bowel movement, eliminating meconium12 and reducing the risk of neonatal jaundice.13
Colostrum's benefits become paramount for preterm and sick infants. The unique ability of mother's milk to adapt to the needs of a baby is especially relevant here. For instance, higher levels of transforming growth factor (TGF)-beta that can stimulate secretory IgA production15 and regulate homeostasis and inflammation16 have been detected in colostrum of mothers with c-section births.17 This is particularly notable since their infants were not exposed to the distinct microbiota/microfl ora of a vaginal delivery. Thus, feeding colostrum may prevent the negative impact of pathogens which often colonize the infant's gastrointestinal tract following c-section.
MORE COLOSTRUM, LESS INTERVENTION
Notably, colostrum of mothers of prematurely born infants has more components for immune and nutritional signalling than term milk.18 It has a lower fat content compared to colostrum of mothers with term born infants, but significantly higher levels of proteins.2 Fresh colostrum is incredibly rich in immunological components such as secretory IgA,6 lactoferrin,19 leukocytes,5 epidermal growth factor20 – growing intestinal mucosa. Pasteurized mature donor milk often given to preterms in the fi rst hours and days simply cannot provide the same benefits. In fact, own mother's milk (OMM) and colostrum, compared to formula, reduces the risk of multiple morbidities and rehospitalisation: necrotising enterocolitis (NEC),21-24 sepsis25, broncho-pulmonary dysplasia (BPD),26 retinopathy of prematurity (ROP),27 neurodevelopmental problems28.
In comparison, donor human milk has been shown to only reduce NEC when it replaces formula in the early days.29,30 Own mother's milk also achieves faster growth outcomes than donor human milk and thus requires significantly less fortification.29,30
MORE EFFORTS, MORE BENEFITS
This is why all mothers need support to provide their colostrum early and frequently to their babies. However, preterm infants often cannot feed and suck effectively at the start due to immaturity and/or the need for respiratory support. In these cases, research suggests oral therapy could do the trick (s. below). Not only does receiving colostrum in this way aid in protecting the infant from pathogens, it also expedites transition to full enteral feeds: Published studies4,7,31 support improved feeding tolerance in infants that receive oral colostrum. This practice also aids with the absorption of nutrients and gut motility.
“With colostrum, information is key. All mothers have to realize why it is so important that those few drops protect their baby.“
Serena Debonnet, midwife, lactation consultant and BFHI coordinator, Belgium
What: Applying small amounts (0.1–0.2 ml) of OMM inside the infant's cheeks, starting from birth within 24 hours after birth and continuing until oral feeds begin.32-36 As regular mouth care for infants that are NPO (nil per os, nothing by mouth) and oral stimulation for non-nutritive sucking (NNS). With enteral feeds, every 3-6 hours are recommended.
Why: Colostrum and early OMM are high in immunologic, anti-infective and anti-inflammatory factors. Oral therapy is therefore considered to function as a form of immune therapy.32-34 Moreover, performing oral therapy has been shown to enhance bonding, promote maternal confidence35 and motivate mothers to continue expressing milk for her infant and increase breast milk feeding rates.36 Research on the clinical benefi ts is continually evolving. To date this practice has been associated with trends towards decreasing the incidences of NEC37,38, late-onset sepsis37,38, reduced days to achieve full enteral feeding37 and shorter hospital stays as well as better nutritional outcomes39. Oral therapy is therefore recommended as routine care for preterm infants in the NICU38.
How: Using a colostrum/OMM covered swab or a 1ml syringe fi lled with 0.1-0.2 ml OMM, small amounts of OMM should be applied inside the infants cheeks, toward the posterior oropharynx for at least 10 seconds. Ideally, mothers are instructed to administer oral care after each pumping session with fresh colostrum/OMM. Make sure to support mothers to express early (within 3 hours after birth) and frequently (8 or more times in 24 hours) to have OMM available.
Fresh is best
Preferably, colostrum should be given to the infant fresh to profit from all its unique ingredients. Live stem cells for example, that have the amazing ability to stir repair processes in the body,5 cannot be found in refrigerated or frozen colostrum, only in freshly expressed drops.52
Oral care with colostrum is safe, inexpensive, feasible and well tolerated even in infants weighing less than 1000 G.33,35,36
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