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.

Feeding Your Baby

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:
- Intravenous (IV) fluids and hyperalimentation
- Gavage or tube feedings
- Nipple feedings
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.
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.
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 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.
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 blood test or by changes in the baby's heart rate pattern
- Hyperglycemia — high amounts of glucose (sugar) in the blood; diagnosed by blood tests, 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

About Breast Milk

Once your baby's condition is stable, including blood pressure and temperature, readiness for milk feedings is checked. 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.
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
A mother's breast milk is the preferred milk for all babies, even the most premature babies. Breast milk contains all the nutrients needed for growth and development. Although commercial milk formulas are designed to be close to breast milk, most are based on cow's milk. The fats in breast milk are more easily digested. Formula is digested more slowly than breast milk and may not be as well tolerated. In addition, breast milk contains antibodies from the mother to help protect babies from infection, something commercial formulas do not have. This protection is especially important when babies are sick or premature and may have higher chances of developing an infection.
Very premature babies may need human milk fortifiers added to breast milk to meet their increased needs for protein, calcium and phosphorus. Even if your baby cannot breastfeed, you can pump your breast milk and it can be stored for gavage or nipple feedings. Depending on the amount of milk needed for feedings, formula may need to be added to breast milk.
Certified lactation consultants (IBCLC) are nurses or other healthcare providers who are specially trained to help women with breastfeeding. In Children’s NICU, these professionals can instruct you in the proper techniques for nursing your baby. They can also teach you about pumping and storing your breast milk for your baby.o teach you about pumping and storing your breast milk for your baby.