Breastfeeding in the NICU (& preemie pumping) – keep this fact sheet

From those moments after birth to the very first feeds, parents of premature babies have a unique start to their journey. Whether your baby is in the neonatal intensive care unit (NICU) due to prematurity or another medical need, having solid support – both emotional and practical – can make all the difference in how you and your baby thrive.

As a preemie mom myself, I know it can feel like a monumental struggle. With my first baby (born at 35 weeks), our breastfeeding didn’t get going until day six after birth. A shared hospital pump was simply not cutting it, and I feared we’d lost that ‘window’ of mom and baby learning together. 

Tears, trial and error

But, thanks to the help of a fantastic on-staff lactation consultant and lots of tears, trial and error, we got there when my little girl was just under a week old. Our first breast feed was on day six, we were combo feeding for a couple of months, and then breastfed exclusively until she was 16 months old. It really doesn’t all have to happen on day one, two or three. 

NICU feeding comes with its own challenges, and many parents rely on breast pumps to establish and maintain their milk supply. But with the right tools, guidance, and expert support, breastfeeding in the NICU is absolutely possible.

Speaking of expert support, we’ve tapped into the incredible team at Cimilre – known for their hospital-strength, whisper-quiet breast pumps that combine power with comfort. With the S6 Adjustable Series, that has GentleFlow Technology, adjustable cycle speeds and suction strength in both modes (that’s 85 setting combinations!), a sleek modern design, and even fun skin decal options to personalize your pump, Cimilre understands what NICU parents need to make their pumping experience as smooth and stress-free as possible.

So, grab your pump, and keep reading for human-led insight, backed by science with Tabatha Young, parent, advocate and CLC (Certified Lactation Consultant) at Cimilre.   

Pumping and breastfeeding in the NICU – what are the challenges?

CLC Tabatha Young explains:

“Many preemies (premature babies) aren’t able to latch right away, so expressing milk with a pump becomes crucial. A high-quality pump can make all the difference in establishing and maintaining  milk supply.”

Beyond latching, NICU parents often juggle feeding schedules, bonding challenges, and the stress of medical uncertainties. Tabatha notes that having a personal breast pump – rather than relying on a shared hospital one – can help mothers pump in the privacy of their baby’s room and build confidence in their feeding journey.

“It’s also a way to feel connected. Even if direct breastfeeding isn’t possible right away, pumping reminds moms that they are providing the very best for their baby.”

It’s no secret that NICU babies often struggle with breastfeeding. Premature babies may have difficulty coordinating sucking, swallowing, and breathing, which can make direct nursing tricky.

“That’s where triple feeding comes in,” says Tabatha. “It’s a combination of breastfeeding, pumping, and supplementing – often with a supplemental nursing system – to help preemies transition to the breast.”

Wait – what’s a supplemental nursing system?

Supplemental nursing systems vary in design but share the same purpose. Typically, they consist of a bottle or small bag filled with breast milk or formula, connected to thin tubes that deliver milk to your baby – often while breastfeeding.

Establishing a feeding routine in NICU

When breastfeeding isn’t immediately possible, establishing a strong pumping routine is key. So, what does that look like?

“Mimicking a newborn’s feeding schedule of every 2-3 hours  – pumping 8-12 times per day – is crucial for milk supply,” Tabatha says. “The first hour after birth is especially important. If nursing isn’t an option, hand expression or an electric pump must be used to stimulate milk production.”

Tabatha also notes that skin-to-skin contact, also known as kangaroo care (or kangaroo mother care), plays a huge role in preemie feeding readiness. Holding your baby close and maintaining contact can help to regulate their breathing, body temperature, and even boost milk production.

NICU milk storage: The do’s and don’ts

Non-NICU babies

For safe storage recommendations – set out in a super-handy table – check Cimilre’s breast milk storage guidelines, which follow CDC standards.

NICU babies

Medically fragile or high-risk infants, including premature babies, have weaker immune systems, making it even more important to follow safe milk storage guidelines. 

KellyMom provides fantastic resources on breast milk storage for premature babies. And crucially, always follow the specific guidelines provided by your NICU, which may vary based on your baby’s specific needs.

In a pinch? Use these 101 tips for NICU milk storage, and grab your nurse for specifics: 

• Use sterile containers for collection
• Label milk with your baby’s name, date, and time of expression
• Keep milk cool during transport using an insulated cooler bag
• Follow the NICU’s instructions for freezing and thawing milk

You might have the 5-5-5 rule in mind here (storing milk for 5 hours at room temp, 5 days in the fridge, 5 months in the freezer), but it’s important to note that this doesn’t currently align with CDC guidelines for breast milk storage.

Going for gold (and long-term success)

Research shows that early and frequent milk expression makes a huge difference in long-term breastfeeding success. A study in Nature found that NICUs with strong breastfeeding support had higher rates of exclusive mother’s milk feeding. Another study from the Canadian Paediatric Society revealed that expressing milk within one hour of birth significantly increases the chances of establishing milk production (and later on, breastfeeding). If a baby is unable to nurse, the only way to do this is with hand expression, or a pump. And, an electric pump is going to make this process much easier and productive. 

“Preemies benefit from breast milk more than ever – it’s packed with immune-boosting properties and helps with neurodevelopment. Even if breastfeeding feels impossible at first, pumping keeps the door open.”

This study suggests that US infant mortality could decrease by approximately 21% if all infants received the recommended six months of exclusive breast milk (not specific to preemies). 

Additionally, infants who are exclusively breastfed for six months develop 20% more white matter (tissue in the brain and spinal cord) and show improved neurodevelopmental outcomes – especially crucial for NICU infants, who face a higher risk of brain injury.

Choosing the right NICU breast pump

For NICU parents, a reliable breast pump isn’t just helpful – it’s essential. Back to me and my own preemie baby, having a better pump while we navigated the hospital setting would have made so much crucial difference. 

At TRB we love specific – the more specific to your situation, the better – and the Cimilre S6+ and S6 Adjustable breast pumps are designed with NICU moms in mind, which we love even more.

These state-of-the-art pumps feature:

Keen to try? Whether baby’s here or you’re planning for post-birth, connect the dots with Tabatha and the team at Cimilre. From finding the right size breast shield to resources for getting started, they’re set up to slot into your support network, from day one.

Remember, take every minute, hour and day as it comes. Exclusive breastfeeding may be the goal (or maybe it isn’t!) but in the short term, setting foundations is the crucial work.