Feeding Your Baby in the NICU

When your baby is in the NICU you want to make the most of the times you have to connect and bond with your child.  Feeding your newborn while he/she is in the NICU can be an important part of that bonding process.

We will support you in learning how to feed your NICU baby, whenever it is safe and medically appropriate. 

How to Feed your Baby in the NICU 

Sometimes, when babies are sick or premature, they are often not well enough to breastfeed or take a bottle. Babies feed by sucking and some NICU babies are  not  strong enough to suck effectively. Premature babies may not be physically mature enough to coordinate sucking, swallowing and breathing, or their gastrointestinal tracts may not be mature enough to digest feedings.

Special pacifiers designed for premature babies are sometimes used to teach them how to suck properly before they begin to breastfeed or bottle feed.

Here are some ways you can participate in feeding your baby:

Gavage or tube feedings

Premature babies, especially those younger than 32 to 34 weeks gestation, may not be able to drink from the breast or bottle. Gavage or tube feedings may be needed until the baby learns to suck effectively. 

For gavage feedings, a small flexible tube is placed into a baby's nostril or mouth and passed down into the stomach.  At first, tiny amounts of breast milk or formula are given through the feeding tube.. Larger babies are able to gradually take larger amounts at each feeding.

Nipple feedings

Feeding from breast or bottle can begin as soon as babies are ready and are able to suck effectively. Your baby may begin nipple feedings while still being tube fed. Sometimes a a baby is able to nipple feed, but not strong enough to obtain all his/her nutrition this way. . As your baby increases the amount he/she can take by nipple, the amount in the tube feedings can be decreased.

Intravenous (IV) fluids and hyperalimentation

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 parenteral hyperalimentation, which contains nutrients they need until they are able to take milk feedings.

The contents of IV fluids and hyperalimentation are carefully calculated for each baby. We calculate the following components:

  • Calories
  • Protein
  • Fats
  • Electrolytes including sodium, potassium, chloride, magnesium, and calcium 

Babies need calories, protein, and fats for adequate growth and development. Fluids, electrolytes, and vitamins are necessary for functioning of body 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.

How will we know when our baby is ready for milk? 

Once your baby's condition is stable, including blood pressure and temperature, readiness for milk feedings is checked. 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.

Your doctor will look for signs your baby is ready including having:

  • Already passed a bowel movement (or meconium, which is the first stool immediately after birth)
  • Active bowel signs
  • Any and all gastrointestinal problems resolved