Feeding and Nutrition
How will my preemie baby get nutrition when s/he is so small?
If your baby is sick or very tiny, your baby will receive nourishment by vein. At first your baby will receive mainly sugar water for calories. However if it appears that your baby will not tolerate feedings within a few days, he/she may be started on total parenteral nutrition (TPN). With TPN, protein, fat, sugar, vitamins and minerals are added to the fluids that the baby receives by vein. Your baby can receive complete nutrition and grow on TPN alone. As your baby tolerates other feedings, the TPN will be decreased.
Your baby may be started on tube feedings. A tube is passed through the mouth or the nose into your baby's stomach. Milk is put through the tube. This may be as a constant slow drip, called continuous infusion or drip feeds, or as prescribed amounts given every few hours, called gavage feeding. Either way, the amounts will be very small at first and gradually increase. There is often a transition period between TPN and tube feedings where the amount of nutrition from TPN slowly decreases as the amount from tube feeding increases.
Occasionally drip feedings are given into the intestine instead of the stomach. In this case the end of the tube is passed beyond the stomach into the intestine.
When will my baby gain weight?
Almost all babies lose weight before they begin to gain weight. This weight loss typically is 5-15% of the baby's birth weight. Much of the weight loss is loss of water because the baby is no longer surrounded by fluid. Sometimes very sick babies gain weight the first few days. This is not real weight gain; it is retention of water. As the baby's condition improves, the baby will lose weight. Usually a baby does not regain his/her birth weight until two or more weeks of age.
When can my baby nipple or breast feed?
When babies are born prematurely their sucking is not well coordinated with their breathing. This suck-swallow-breathe pattern usually becomes coordinated enough to safely breast or bottle feed at about 34 weeks of gestation. However, there are big differences among babies. Some are ready at 32 weeks; others are not ready at 36 weeks. Nurses can often tell when a baby is getting close to this time by how a baby acts during a tube feeding. Your baby's doctors and nurses will determine when to start. At first your baby will have only one or two feeds a day that are not by tube. This will gradually increase as the baby gets used to the extra work of feeding. Because nipple and breast feeding requires more work, babies who have had severe respiratory problems may be slower to start and slower to advance on feedings. Before your baby is ready to feed by breast or bottle, s/he may enjoy sucking. A pacifier may be used to encourage sucking. When the baby is being tube fed, s/he may like to suck on a pacifier or the breast that is empty of milk. This is called non-nutritive sucking. Sucking on the empty breast or nuzzling the breast during tube feeding can be combined with kangaroo care. This helps the mother with milk production and readies the baby for future breast feeding. In addition, babies stay warm while held.
Should I plan to breast or bottle feed my baby?
There are many advantages to mother's breast milk over formula. These advantages include:
- Fewer infections
- Less risk for Necrotizing Enterocolitis (NEC)
- Better tolerance of feeds
- Less risk of allergy
- Enhanced development
Early breast milk, called colostrum, is especially rich in antibodies and cells that help fight infection. Babies who are too young to suckle at the breast can get your milk in their tube feedings. Even if you planned to bottle feed or cannot breast feed long term, you might consider providing breast milk for your preemie while s/he is in the hospital. It is something special that only you can do for your baby.
Are there mothers who can't or shouldn't breast feed?
Very few mothers can't or shouldn't breast feed. Most drugs do not get to the baby in large enough amounts to prevent breast feeding. Be sure you let your baby's doctor know all medicines, herbs or other drugs that you are taking. The following mothers usually should not breast feed:
- Mothers getting chemotherapy and or radiation for cancer
- Mothers with HIV or AIDS
- Mothers on medicines that collect in breast milk in large amounts or are dangerous to the baby
If you have had surgery or radiation to your breasts (especially near the nipple), it may be difficult to lactate (produce milk). If only one breast has had surgery or radiation, the other should be able to produce enough milk for your baby.
How is breast milk formed?
The breasts contain many glands which make milk. They collect nutrients and liquid from the mother's blood and make them into milk. The milk then travels to ducts which help store the milk. The ducts are behind the brown part of the nipple and each duct has a connection to the nipple. When the nipple is stimulated by sucking (or suction), hormones are released in the mother's brain which help bring the milk to the nipple. This is called "let down".
How will my body know to produce milk early?
After delivery, hormones change rapidly, signaling to your breast to begin making milk. With stimulation by the baby's sucking (or by the breast pump) the breasts will continue to make milk. The more stimulation the more milk the breasts make.
When should I start pumping?
It is best to start as soon after delivery as you can, within the first 6 hours is best, but definitely within the first 24 hours. Early pumping is very important for establishing a milk supply. Even if your baby is very sick and not being fed, you need to pump your breast regularly so there will be milk when your baby is ready. Electric breast pumps are the best. Ask your nurse or a lactation consultant for assistance in learning to use one and in preparing to rent one when you are out of the hospital.
How often should I pump?
You should pump 8 to 12 times a day for 10-15 minutes per side or until empty in combination with hand expression. Hand expression and frequent pumping signal your body to keep making milk. At first you may get very little milk, sometimes just a few drops. But, it is important to save all that you get of this early milk for your baby. Within a few days your breasts will become full and swollen. This is your milk coming in. At this time you would expect your milk supply to increase. Depending on how early your baby is born you may produce more than your baby can use at that moment, but don't decrease the amount of pumping. It is important to build a good supply early on.
My baby is sick and not eating. What do I do with my milk?
Continue to pump and bring your milk to the NICU. The care team will help you devise a plan of how much milk to keep fresh and when it is the right time to freeze your milk.