Nutrition for babies in the NICU:

Mothers of preemies who breastfeed provide their babies with milk especially formulated for preemie development. Preemies receive many benefits from breastfeeding, including protection against infection, better developmental outcome and reduced stress. However, there are many mothers who cannot breastfeed and while this is not ideal, most babies do very well with either donated milk or formula.

For additional information on feeding, please see “Feeding” and “NICU Lingo“.

Intravenous (IV) fluids and TPN

Many babies in the NICU receive essential fluids and electrolytes through a tube in a vein called an IV. Some babies may need a special preparation called TPN — Total Parenteral Nutrition (also known as parenteral hyperalimentation), which contains nutrients they need until they are able to take milk feedings.

The contents of IV fluids and TPN are carefully calculated for each baby. Calories, protein, fats and electrolytes — including sodium, potassium, chloride, magnesium and calcium — are all important components. Babies need calories, protein and fats for adequate growth and development. Fluids, electrolytes and vitamins are necessary for proper functioning of the body’s systems.

Blood tests help determine how much of each component a baby needs and the amount of each nutrient can be increased or decreased accordingly. Daily weights and keeping track of a baby’s urine output also help monitor fluid needs.

Monitoring your baby’s electrolyte and blood levels

Some babies have too much or too little of certain electrolytes or other components in the blood. As a result, some of the common problems include the following:

• Hypernatremia: High amounts of sodium (salt) in the blood.
• Hyperkalemia: High amounts of potassium in the blood; can be diagnosed by a blood test, or by changes in the baby’s heart rate pattern.
• Hyperglycemia: High amounts of glucose (sugar) in the blood; diagnosed by a blood test, often done by heel stick; some babies may need insulin to control high glucose levels.
• Hypoglycemia: Low blood sugar; usually treated with IV fluids containing dextrose (another form of sugar).
• Hypocalcemia: Low calcium levels in the blood; usually treated with calcium in IV fluids.

Determining if your baby is ready for milk feedings

Once your baby’s condition is stable, readiness for milk feedings is checked.
Babies need to:

• Show signs of sucking
• Have active bowel sounds
• Have passed meconium stools (baby’s first bowel movements)
• Have no signs of abdominal distention or infection

Most babies older than 28 weeks gestation have digestive tracts mature enough for milk feedings. Once your baby is taking milk feedings well and is gaining weight, intravenous (IV) fluids and hyperalimentation can be decreased.

Sick babies may not be strong enough to suck effectively. Premature babies may not be physically mature enough to coordinate sucking, swallowing and breathing, or they may be too weak to suck for long periods of time. Special pacifiers designed for premature babies are sometimes used to teach them how to suck properly before they begin to breastfeed or bottle feed.

Gavage or Tube Feedings:

Premature babies, especially those younger than 32 to 34 weeks gestation, often cannot be fed from the breast or bottle. Tube feedings, also known as gavage feedings, may be needed until the baby learns to suck effectively. A small flexible tube is placed into a baby’s nostril or mouth and passed down into the stomach. The tube is sometimes removed, but may be left in place if feedings are frequent.

At first, tiny amounts of breast milk or formula are given through the feeding tube. Because of their small stomach size, very tiny babies may be fed using a pump that slowly delivers the milk in small amounts. As the babies grow, they’re able to gradually take larger amounts at each feeding.

Before each tube feeding, a baby is checked for residuals (GR — gastric residual volume), the amount of milk in the stomach left over from the last feeding. If the amount of residual is too high, it may mean the baby is not digesting food well or is perhaps aspirating.

Nipple Feedings:

Feeding from breast or bottle can begin as soon as babies are stable and are able to suck effectively. Your baby may begin nipple feedings while still being tube fed. Even if a baby is able to breastfeed, it can be tiring. The process requires patience! As your baby increases the amount he or she can take by nipple, the amount in the tube feedings can be decreased.

Intravenous line (IV):

Babies may have an IV placed in a hand, foot or scalp, where veins are easily accessible. Tubing connects the IV to a bag containing fluids which are then carefully delivered with a pump.

Umbilical Catheter:

After the umbilical cord is cut at birth, newborn babies have the short stumps of the cord remaining. Because the umbilical cord stump is still connected to their blood and circulatory system, a catheter (small flexible tube) can be inserted into one of the two arteries or the vein of the umbilical cord. Medications, fluids and blood can be given through this catheter. After placement of the umbilical catheter, X-rays are taken to check the location in the baby’s body.

PICC Line:

A catheter is placed in a deep vein or artery in the baby’s arm or leg and is used for meeting a baby’s longer-term needs than a standard IV in the hand or scalp.