While babies are in the uterus they receive a steady flow of nutrients from their mother through their umbilical cord. After birth, it’s not as easy for them to get those nutrients since mom’s body isn’t directly supplying them anymore. Babies, who are born prematurely weighing 1250 g or less, cannot be fed by mouth or with a bottle. Breast or nipple feedings may be too strenuous for their tiny bodies. In addition, they have immature feeding reflexes and cannot swallow, or suck on their own.
As a result, the baby’s health care team will supplement or replace standard feedings with tube feedings. The tube goes in either their nose or mouth and down to their stomach to deliver the nutrients with no effort from the baby. Infants who cannot tolerate being fed through a tube will often start their feedings intravenously (IV). The IV fluids are often pushed through the umbilical cord, then later transition into their hands, arms and feet. Once the baby starts tolerating increasing amounts of milk feeding, doctors slowly decrease or “wean” the amount of IV fluids or parenteral nutrition (high calorie, protein, fat and mineral IV solution) until the tube feedings become the sole source of nutrition for the baby.
These tube feedings typically consist of mom’s pumped breast milk. If mom’s milk is not available or is not available in sufficient amount to meet baby’s nutritional needs, donor breast milk or decreasingly common, premature infant formula may be added. A recent statement by the American Academy of Pediatrics states that all premature infants should be fed only human milk (and not formula).1
Since breast milk does not have sufficient protein, calories, or minerals to meet the needs of a premature baby a fortifier is added to mom’s milk, or donor milk if that is being used. Use of a human milk based human milk fortifier as part of a 100% human milk diet, has been shown in recent studies2,3 to decrease the odds of developing necrotizing enterocolitis (NEC), a potentially deadly intestinal complication in these infants.
As baby grows and matures, the NICU staff will begin to transition feeding from the tube to oral feeds either at the breast or from a bottle. Even if mom prefers bottle feeding it is recommended that she should continue to pump her own milk to be fed via the bottle.
- American Academy of Pediatrics. Breastfeeding and the Use of Human Milk. Section on Breastfeeding. [originally published online February 27, 2012]. Pediatrics. DOI: 10.1542/peds.2011-3552.
- Sullivan S, Schanler RJ, Kim JH et al: “An exclusively human milk- based diet is associated with a lower rate of necrotizing enterocolitis than a diet of human milk and bovine milk-based products”. J Pediatr 2010 DOI: 10.1016/j.jpeds.2009.10.040.
- Cristofalo EA, Schanler J, Blanco CL, et al. Exclusive human milk vs preterm formula: randomized trial in extremely preterm infants. Chart presented at: Pediatric Academic Societies and Asian Society for Pediatric Research 2011 Joint Meeting, Neonatal Fetal Nutrition and Metabolism Poster Session; April 30, 2011; Denver, CO.