Nutrition for a Preterm Baby in the NICU

How a baby is fed in the NICU

There are several ways to feed a baby while they are in the NICU:

• Your baby may be fed through an I.V. (intravenous line). This is a thin tube that goes into the vein.

• A tube may be used to send formula or breast milk into your baby’s stomach. This is called a gavage feeding.

• Your baby may be able to breastfeed or bottle-feed right away.

How your baby is fed will depend on their health and gestational age. Your baby will likely be feeding from a breast or a bottle before going home.

What a baby is fed in the NICU

• Total parenteral nutrition (TPN). This is a liquid that has all the nutrition your baby needs. A baby gets this through a vein. TPN is given to most very early preemies. This is because their digestive systems are not yet mature. They can’t get enough nutrition through regular feedings.

• Breast milk. Your baby will get the best nutrition and protection from breast milk. It can be given at your breast or with a bottle. It can also be given with a gavage feeding. Many preemies learn to breastfeed while in the NICU. Ask the NICU staff the best way to pump and store breast milk for your baby. For a preterm baby, the breast milk may be mixed with a protein and mineral supplement (fortifier). This is to help your baby's growth. Breast milk is good for a preterm baby because it lowers the chance of infections. And it is easiest to digest. Many NICUs will give donor breast milk to very small preemies whose birth parents don't have enough breast milk yet.

• Formula. Special formulas are made for the needs of preemies when breast milk is not an option. The NICU team will give this formula to your baby with a gavage feeding or a bottle.

From TPN to full breastfeeding or bottle-feeding

If your baby started on TPN, moving to full breastfeeding or bottle-feeding may take  3 to 4 weeks. This depends on your baby’s gestational age. A baby is often able to start learning to feed from a breast or a bottle by 32 to 34 weeks gestation. To reach this goal, TPN is decreased. Gavage feeding will provide most of your baby's nutrition until they can fully feed by mouth.

Gavage feeding goes into the stomach rather than a vein. This is also called enteral nutrition. It starts with a small amount of breast milk or formula. As your baby grows stronger, the amount of breast milk or formula is increased.

A baby who is not ready to take all their feedings by mouth can still have gavage feeding without TPN. In some cases, a baby who is having a health problem may need to go back to TPN for a time. Breast milk or formula will be started again when the baby is ready.

Talk with the care team

You may have questions or want to learn more about how your baby is fed in the NICU. If so, talk with the NICU nurses. They are there to help you and your baby during this time.