When going through pregnancy, most mothers expect to have nine months to prepare for a newborn. Caring for a preemie, however, is not something that pregnancy books and newborn care classes cover.
In terms of preemie nutrition and feeding, the following information can help prepare you or provide insight into what you may be experiencing:
1. Nutrition support
This refers to an alternate route of nutrition for your baby. Babies may require nutrition support if they have low birth weight or other medical complications. If born before 34 weeks, he or she may not be able to coordinate sucking, swallowing, and breathing during oral feeding. Your baby may receive breastmilk or formula through a tiny tube that goes into the nostril or mouth and down to the gut (enteral nutrition). In cases of very early preemies, many have to receive parenteral nutrition, or nutrition through an IV (intravenous). This is because their digestive system is not yet developed enough to handle the full volume of breastmilk or formula that is required to sustain growth. There can be a number of factors that limit an infant’s ability to tolerate enteral nutrition, and parenteral nutrition becomes necessary.
2. Fortified breast milk or special formulas
Being outside the womb early presents challenges and demands on the infant’s body that can increase nutrition needs. Preemies with low birth weight need more calories, protein, vitamins and minerals than infants born at full term, to promote “catch up growth”. Human breastmilk has been analyzed from mothers of preemies and mothers of term infants, and preemie breastmilk actually contains more calories, protein, vitamins and minerals than term breastmilk. Often times, preemie breastmilk needs to be fortified further to meet the infant’s needs. There are also formulas designed for premature infants in the event that breastmilk is not available. Proper nutrition is critical for the development of vital organs like the lungs, heart, brain, and gut. Neonatologists and registered dietitians assess each baby in the NICU for nutrition needs, and create individualized recipes and feeding regimens. Sometimes these special recipes and feeding regimens need to be continued once the baby goes home from the NICU, and parents get educated by the medical team on how to do this.
3. Swallowing or oral feeding issues
Babies develop the ability to coordinate sucking, swallowing, and breathing around 33 or 34 weeks. There are a number of circumstances that may impact this developmental stage for preemies born prior to that. The baby may require a ventilator for oxygen, which would not allow oral feeding to occur. Or, the baby may require nutrition support during this time for a variety of reasons, and oral feeding attempts may not be possible. These scenarios can have lingering effects on how the baby feeds and swallows in the future. Babies may require special feeding techniques or “thickened” liquids if they have swallowing difficulties. Sometimes babies develop oral sensory issues and aversion to oral feeds, in which case tube feedings may continue until this is overcome.
An article published in Neonatology in 2008 titled “Strategies for feeding the preterm infant”, by Dr. William Hay, provides a review of preemie nutrition (for free full text, click here). As your infant gets older, his or her nutrition needs will change. Growth should be monitored closely by your child’s doctor. Nutrition is critical, and expert care should be provided to ensure maximum development. If you or your doctor has concerns about growth, nutrition, or feeding, schedule an appointment with a dietitian at North Shore Pediatric Therapy.