Feeding Preterm Babies

While in-womb, babies learn to coordinate the sucking, swallowing and breathing needed for feeding only at about 34 to 36 weeks of pregnancy. If your baby is born before this time, they may need to have breast milk via a feeding tube to begin with. This goes through their nose or mouth into their stomach.

Even a full-term baby sometimes struggles with getting the actions of sucking and swallowing in order, so you can imagine how much tougher it is for preterm babies.

Feeding required a combination coordination of skills. For the infant, it is a complex and physically demanding task. A single swallow requires the use of 26 muscles and 6 cranial nerves1 working in perfect harmony to move food and liquid through the body.  

Those who are born just 3 or 4 weeks early are usually able to breastfeed after birth with some trial and error. Same for babies who were born close to term but at a low birth weight. But babies born before 34 to 36 weeks usually have special nutritional needs that traditional feeding can’t satisfy not only because they’re born smaller, but because they grow at a faster rate than full-term babies do, may not be able to suck effectively, and/or may have digestive systems that are less mature.  

Medical experts say that the vital nutrients need to be given in the most concentrated form possible for two reasons:

Their tummies are so tiny that they can  only tiny amounts of food at a time Their immature digestive systems are weak, making the passage of food a very slow process.

The current trends are to add fortification to the milk so that more nutrients can be absorbed.

Immediately After Birth

When a baby is born preterm, and/or is low in birth weight, the entire neonatal section of the hospital gets into action. Read on to know what are the various steps that could be possibly taken:

IV Feeding

An intravenous solution of water, sugar, and certain electrolytes is often given to prevent dehydration and electrolyte depletion. Very sick or small babies (usually those who arrive before 28 weeks gestation) continue to receive nutrition through their IV called Total parenteral nutrition (TPN) or parenteral hyperalimentation, this balanced blend of protein, fat, sugar, vitamins, minerals, and IV fluids is given until the baby can tolerate milk feedings.

Gavage feeding

Gavage is a tube placed through your baby's nose (called a Nasogastric or NG tube) that carries breast milk/formula to the stomach. TPN will decrease Gavage feeding. Babies who arrive between 28 and 34 weeks gestation and who don’t need IV nutrition (or babies who started out on TPN but have progressed to the point where they can tolerate milk feedings) are fed by gavage, a method not dependent on sucking, since babies this young usually have not yet developed this reflex. Prescribed amounts of pumped breast milk, fortified breast milk, or formula are fed through the tube every few hours. Gavage tubes are either left in place between feedings or removed and reinserted for each feeding. (The tube won’t bother your preemie because the gag reflex doesn’t develop until about 35 weeks.)

You can still take part in feedings by holding the tube and measuring how much your baby takes, cuddling skin-to-skin during tube feedings, or giving your baby your finger to practise sucking on while he or she is being fed (this helps strengthen the sucking reflex and may also help your baby associate sucking with getting a full tummy).

Feeding from the Nipple

Once your newborn has passed a test that has the following questions, your medical team will work on getting him started on your breast. Some will be ready as early as 30 to 32 weeks of in-womb age while other babies won’t be ready to take on the nipple until 34 or even 36 weeks.

Questions

• All well in the abdomen? Meconium has been passed? No digestive infection?
• Are the basic parameters stable?
• Is the baby ready to be handed into your arms?
• Can a baby suck rhythmically on a pacifier or feeding tube and coordinate breathing and sucking?
• Is the baby awake for longer periods?
• Are there any respiratory problems? Any episodes of apnea (when breathing stops)?

The point to note is that nipple feedings are tiring. It is a lot of hard work to suck and swallow. Hence, they will be started slowly one or two a day and alternated with tube feedings.