Nutrition for Premature Infants in the NICU

For a time, your baby will be cared for in the NICU (neonatal intensive care unit). There are several ways to feed babies while they’re in the NICU. Your baby may start by being fed through an IV (tube that goes into the vein). A tube may be used to send formula or breastmilk into the baby’s stomach (a gavage feeding). Or your baby may be able to go directly to breast or bottle feeding. Which method is best depends on your baby’s health and gestational age. Your baby will likely be feeding from a breast or bottle before leaving the NICU to go home.

What Are Babies Fed in the NICU?

• Total parenteral nutrition (TPN). This is a solution that provides all the nutrition your baby needs. It is given through the vein. Most very early preemies will be given TPN. This is because their digestive systems are not yet mature, so they can’t absorb enough nutrition through regular feedings.

• Breast milk. Your baby can be given pumped breast milk with a gavage feeding or with a bottle. Many preemies learn to breastfeed while in the NICU.

• Formula. Special formulas are designed for preemies’ needs. This will be used if you are unable to breastfeed or choose not to. It may also be used to supplement breast milk. Formula can be given with a gavage feeding or a bottle.

TPN is used to give your baby nutrition until the baby’s digestive system is ready for gavage, breast, or bottle feeding. Shaded spots are possible insertion sites for a TPN line.

A gavage tube goes through the baby’s nose down into the stomach. It can be used to give your baby breast milk or formula.

How Does a Baby Move from TPN to Full Breast or Bottle Feeding?

If a baby has started on TPN, moving to full breast or bottle feeding may take 3–4 weeks. This depends on the baby’s gestational age. A baby is often able to feed from your breast or a bottle by 32–34 weeks gestation. Gavage feeding may be tried first with younger preemies. In any case, the baby is started on a small amount of breast milk or formula. The amount of breast or formula feedings is increased as the baby grows stronger. At the same time, TPN is decreased. The goal over time is to work up to full feeding. This is often calculated as 150–180 mL of breast milk or formula, per kilogram, per day. In some cases, a baby who is having a medical problem may need to go back to TPN for a time. If this happens, breast milk or formula feeding will be started again when the baby is ready.