The survival chances of preterm infants have improved considerably in the last few decades. The advantages of giving breast milk to neonates and infants for a sufficiently long period using this as the sole feeding method as far as possible have been sufficiently demonstrated. At least for preterm infants, breast milk is additionally an urgent medical and thus simultaneously a therapeutic intervention: it significantly reduces the typical morbidity of these children, increases the survival rate and improves long-termoutcomes.This book aims to summarise theoretical principles of breastfeeding in preterminfants and neonates and their practical implementation in the difficult everyday setting of a neonatology unit. But it also attempts to define the context and framework conditions in which it is possible to also feed very small preterminfants using their mother's milk as exclusively as possible and for a sufficiently long time, specifically through breast-feeding.International authors from very different professions convey their expertise to give the very smallest babies the best chances for their long-termdevelopment and moreover to provide food for thought about moving away from traditional strategies of feeding and behaviour.

1. Introduction (Th. Kühn) 132. Breastfeeding of preterm and term infants: the German guidelines of theNational Breastfeeding Commission (M. Abou-Dakn) 153. Physiological basis of milk production and composition of human breastmilk (N. Haiden) 173.1. Physiological processes in milk production 173.1.1. Lactogenesis I 173.1.2. Lactogenesis II 173.1.3. Galactopoiesis 173.2. Composition of breast milk 193.2.1. Change in composition during lactation 193.2.2. Change in composition during the breast feed 193.2.3. The individual ingredients and their function 193.2.4. Bioactive factors the microbiome of breast milk 213.2.5. Breast milk of the mother of a preterm infant 224. Breastfeeding and nutrition through breast milk as health prevention:long-term effects (A. Kribs) 244.1. Occurrence of infections 244.2. Disorders related to metabolic syndrome 254.3. Neurological development 265. Growth and thriving of preterm infants while receiving breast milk(Th. Kühn) 295.1. Importance of adequate growth 295.2. Feeding interventions in preterm infants 325.2.1. How should preterm infants grow postnatally and how do they grow in reality? 325.2.2. Which parameters are suitable for assessing optimal postnatal growth? 355.2.3. Which growth curves should be recommended? 365.2.4. What influences premature growth? 365.2.5. Catch-up growth after preterm birth 395.2.6. Early growth and long-term consequences 395.2.7. Nutrient requirement and composition in the feeding of preterm infants 405.2.8. Introduction of oral feeding 405.3. Growth of preterm infants being fed with breast milk 425.3.1. The influence of exclusive feeding with breast milk and especially breastfeeding of preterminfants at the time of discharge on subsequent growth and neurological outcome 435.3.2. Nutrition of preterm infants after discharge 446. Fortification of breast milk and target fortification (Ch. Fusch) 496.1. Preterm infants have higher growth rates than term infants, raw breast milk cannot cover theirrequirement 496.2. How can the nutrient requirements of preterm infants actually be covered? 496.2.1. Standard fortification of breast milk 496.2.2. Disadvantages of standard fortification 506.2.2.1. ELBW preterm infants 506.2.2.2. Donor milk 506.2.2.3. VLBW preterm infants and variability of breast milk composition 506.2.3. Breast milk does not have a constant composition, but shows intraindividual andinterindividual fluctuations 516.2.4. Adjustable fortification of breast milk 526.2.5. Target fortification 536.2.6. How can the content of breast milk be measured in practice? 546.3. Which products are available for fortification of breast and donor milk? 546.4. Fortifiers based on breast milk (H2MF, Human Milk Fortifier) 546.5. Time of fortification 556.6. General disadvantages of fortification 557. Early breastfeeding competence in preterm infants (K. Hedberg Nyqvist) 587.1. Criteria for introduction of breastfeeding no suck assessment or training 587.2. Early nutritive sucking capacity verified by structured breastfeeding observations 587.3. Breastfeeding observations confirmed early sucking competence in preterm infants 607.4. Non-nutritive sucking opportunities 617.5. Practical breastfeeding support 617.6. Breastfeeding positions 637.7. Feeding routines that support early breastfeeding competence in preterm infants 637.8. The Baby-Friendly Hospital Initiative adapted for neonatal intensive care 648. Drinking pattern of preterm infants and dealing with bottle-feeding(D. Biber) 658.1. Non-nutritive sucking and first experiences with milk 668.2. First attempts at drinking with the bottle 668.3. Quality instead of quantity 678.4. Stress reactions when feeding 688.5. Supportive measures during bottle feeding 688.6. Feeding means communication and bonding between mother and child 709. The practice of breastfeeding in preterm infants (G. Nindl) 729.1. Bonding shortly after birth 729.2. Kangaroo Mother Care / skin-to-skin contact 729.3. Obtaining breast milk and establishing lactation 739.4. Supportive environment 749.5. First attempts at putting the baby on the breast 759.6. Guiding to the breast 759.7. Non-nutritive sucking at the breast 769.8. Feeding by gastric tube at the breast 769.9. Positions to support breastfeeding 779.10. Milk transfer and nutritive sucking 789.11. Weighing and checking weight 799.12. Breastfeeding and additional tube-feeding 799.13. Observing and reflecting 799.14. Breastfeeding and supplementary feeding 809.15. Management at discharge 819.16. Breastfeeding of late preterm babies 829.17. General conditions to facilitate bonding and breastfeeding 8310. Evidence-based recommendations on breastfeeding for neonatology(M. Berns) 8610.1. Importance of breast milk for preterm infants 8610.2. Skin-to-skin contact bonding Kangaroo Mother Care 8610.3. Obtaining milk 8710.4. Learning to suck 8710.5. Non-nutritive sucking 8710.6. Actually breastfeed! 8811. Breastfeeding and promoting breastfeeding as a process: the case forclinical care pathways (M. Keller) 9011.1. Problem of interfaces 9011.2. Clinical care pathways 9111.3. Promotion of breastfeeding as a treatment process based on the example of the family-centredNeoPAss® care pathway 9412. Donor breast milk and breast milk banks (C. Gebauer) 9612.1. Historical development 9612.2. Current situation 9713. Structure and organisation of a breast milk bank for extremely immaturepreterm infants on the ICU (S. Herber-Jonat) 10113.1. Approval conditions, infrastructure and costs 10113.2. Provision of breast milk at Großhadern Perinatal Centre 10214. Milky Ways Milk banks: Local challenges and global solutions(G. Weaver) 10715. Management of breast milk: practical details for everyday work on the NICU(S. Kietzerow, Th. Kühn) 11015.1. Prerequisites for lactation after premature birth 11015.2. Breastfeeding aids for mothers of preterm infants (63) 11215.3. Recommendations on storage of breast milk on the NICU 11415.4. Breastfeeding room versus pumping next to the child 11515.5. Dealing with micro-organisms and the pasteurisation of breast milk 11715.5.1. Viral infections 11715.5.2. Bacterial infections 12015.5.3. Pasteurisation 12015.5.4. Freezing followed by thawing 12016. Promoting breastfeeding and counselling for mothers of preterm infantsin outpatient practice (K. Bautsch) 12317. List of abbreviations 126Index 127