A Parent's Guide to the NICU

Feeding and Nutrition

How will my baby get nutrition when s/he is sick?

If your baby is sick or very tiny, your baby will receive nourishment by vein. At first your baby may receive total parenteral nutrition (TPN). With TPN, protein, fat, sugar, vitamins and minerals are added to the fluids that the baby receives by vein. Your baby can receive complete nutrition and grow on TPN alone. As your baby tolerates other feedings, the TPN will be decreased.

Your baby may be started on tube feedings. A tube is passed through the mouth or the nose into your baby's stomach. Milk is put through the tube. This may be as a constant slow drip, called continuous infusion or drip feeds, or as prescribed amounts given every few hours, called gavage feeding. Either way, the amounts will be very small at first and gradually increase. There is often a transition period between TPN and tube feedings where the amount of nutrition from TPN slowly decreases as the amount from tube feeding increases.

When will my baby gain weight?

Almost all babies lose weight before they begin to gain weight. This weight loss typically is 5-15% of the baby's birth weight. Much of the weight loss is loss of water because the baby is no longer surrounded by fluid. Sometimes very sick babies gain weight the first few days. This is not real weight gain; it is retention of water. As the baby's condition improves, the baby will lose weight. Usually a baby does not regain his/her birth weight until two or more weeks of age.

When can my baby nipple or breast feed?

When babies are born prematurely their sucking is not well coordinated with their breathing. This suck-swallow-breathe pattern usually becomes coordinated enough to safely breast or bottle feed at about 34 weeks of gestation. However, there are big differences among babies. Some are ready at 32 weeks; others are not ready at 36 weeks. Nurses can often tell when a baby is getting close to this time by how a baby acts during a tube feeding. Your baby's doctors and nurses will determine when to start. At first your baby will have only one or two feeds a day that are not by tube. This will gradually increase as the baby gets used to the extra work of feeding. Because nipple and breast feeding requires more work, babies who have had severe respiratory problems may be slower to start and slower to advance on feedings. Before your baby is ready to feed by breast or bottle, s/he may enjoy sucking. A pacifier may be used to encourage sucking. When the baby is being tube fed, s/he may like to suck on a pacifier or the breast that is empty of milk. This is called non-nutitive sucking. Sucking on the empty breast or nuzzling the breast during tube feeding can be combined with kangaroo care. This helps the mother with milk production and readies the baby for future breast feeding. In addition, babies stay warm while held.

Should I plan to breast or bottle feed my baby?

Just because your baby is premature does not mean s/he must have formula. In fact, there are many advantages to mother's breast milk over formula. These advantages include:

• Fewer infections
• Less risk for Necrotizing Enterocolotis (NEC)
• Better tolerance of feeds
• Less risk of allergy
• Enhanced development

Early breast milk, called colostrum, is especially rich in antibodies and cells that help fight infection. Babies who are too young to suckle at the breast can get your milk in their tube feedings. Even if you planned to bottle feed or cannot breast feed long term, you might consider providing breast milk for your baby while s/he is in the hospital. It is something special that only you can do for your baby.

Are there mothers who can't or shouldn't breast feed?

Very few mothers can't or shouldn't breast feed. Most drugs do not get to the baby in large enough amounts to prevent breast feeding. Be sure you let your baby's doctor know all medicines, herbs or other drugs that you are taking. The following mothers usually should not breast feed:

• Mothers getting chemotherapy and or radiation for cancer
• Mothers with HIV or AIDS
• Mothers on medicines that collect in breast milk in large amounts or are dangerous to the baby

I can't or don't wish to breast feed. Will I be hurting my baby?

Babies can and do develop normally when fed only formula. Although encouraged, breast feeding is a personal choice. You and your baby can still benefit from close skin to skin contact.

Please see more about breast feeding on the parenting page.