Nutrition and Breastfeeding

Good nutrition is important for the growth and development of babies born early or who are ill. Some babies may be too immature to suck, while other babies’ digestive systems are unable to handle normal feedings. We tailor our feeding techniques according to your baby’s unique condition.

Intravenous (IV) Fluids

The health care team will determine the IV solution and/or types of feedings best suited for your baby’s needs. When your baby’s digestive system can tolerate breast milk or formula, IV fluids will be slowly decreased as feedings are increased

Intravenous (IV) nutrition that may be used for your baby include:

• Glucose Solution (a sugar-water solution) - Electrolytes (nutrients) such as sodium, potassium, calcium and protein may be added to these glucose solutions.
• Hyperalimentation - An IV solution containing glucose, protein, vitamins and minerals that is sometimes called Total Parenteral Nutrition (TPN). The IV fluid is usually yellow because of the vitamins it contains.
• Lipids - A special fat solution given to make sure your baby receives the calories that are needed for growth and development. This IV solution is a white, milky color.

Your baby receives this nutrition in one of several ways:

Peripheral IV Catheter

A short, soft tube may be inserted into your baby’s vein:

• to supply fluids and nutrition,
• to send medication directly into your baby’s bloodstream, or
• to replace some of your baby’s blood.

Because babies’ veins are small and fragile, an IV can come out easily or the IV site may become irritated. It may be necessary to restart the IV several times. Your baby’s arms, hands, legs, feet, and scalp are possible sites for peripheral IVs.

Peripherally Inserted Central Catheter (PICC)

A PICC may be used if the baby requires IV therapy for an extended time. A very thin, long tube is placed in a vein in the arm, leg, or scalp and moved into the central circulation. The PICC usually remains in place longer than an IV, so the number of times an IV site must be changed is less. Some fluids cannot be given through a PICC, so a peripheral IV may also be needed. Some babies require long-term IV therapy through surgically placed central lines. A pediatric surgeon inserts the central line if needed.

Umbilical Lines (UACs and UVCs)

An umbilical venous catheter (UVC) is a long tube inserted into the baby’s umbilical cord vein. It is used to give IV fluids and medications. An umbilical arterial catheter (UAC) is inserted into the baby’s umbilical cord artery. Blood samples can be taken from the UAC and used to check levels of oxygen or nutrients in the blood. The umbilical cord does not have nerve endings so this is not a painful procedure.

Breast Milk or Formula Feeding

When your baby is able to be fed, the types of nutrition and feeding methods include:

Mother’s Breast Milk/Breastfeeding:

When a baby is unable to breastfeed the mother must use a breast pump to obtain breast milk for her baby. Mother’s breast milk provides the best nutrition, protects baby from illness, is easily digested, and enhances baby’s development.

Donor Breast Milk

If mother’s own milk is not available, human milk that is thoroughly screened, processed and pasteurized from an approved human milk bank may be helpful to a premature baby. Donor milk is used for a short time until mother’s milk is available. The health care team will discuss the use of donor breast milk and get permission from you for its use if it may benefit your baby.

Special Formulas

When breast milk is not available special formulas made especially for premature babies are used. These have extra nutrients and more calories than regular formulas. The health care team will determine what is best for your baby.

Tube (Gavage) Feeding:

Many babies, especially when they are born early, may be too immature or too sick to suck. In order to give the good nutrition of breast milk or formula your baby may be fed using a soft, thin feeding tube. The nurse will gavage-feed your baby by passing the tube through the nose or mouth and into the stomach. The tube is taped in place and used when your baby requires a tube feeding. Feedings will be started slowly using small amounts of about a teaspoon per feeding. Gavage feedings are done every three hours or sometimes continuously by a pump. Your baby will be offered a pacifier to suck on during gavage feedings.

Nipple Feeding

A premature baby must learn to organize sucking, swallowing, and breathing while breastfeeding or taking a bottle. When your baby is about 33 weeks he usually gives cues or signs that he is ready to breastfeed or nipple feed. These include waking up before feeding, actively looking for something to suck on or sucking strongly on a pacifier. As your baby gains strength and maturity, breastfeeding or bottle feeding will be introduced. As the number of breast feedings or nipple feedings increase, the number of gavage feedings will decrease. Your baby will be taking all of his feedings by nipple before going home.

Feeding Challenges

For babies born prematurely, digestion can be difficult when feedings are started. A swollen abdomen, spitting up, the presence of aspirates (undigested food in the stomach from a previous feeding), or bloody stools could indicate other problems. The amount of feedings given to your baby may have to be decreased or stopped for a period of time until the problem is identified or resolved.