Nutrition for premature babies

What is preterm?

• The term ‘preterm’ applies to babies born early, i.e. before 37 weeks gestation
• They’re often of low birthweight i.e. weighing less than 2.5 kg (about 5.5 lbs) at birth
• A significant proportion of a baby’s weight gain happens between weeks 36 and 40 of pregnancy and therefore preterm infants will need to catch up on this weight gain that they will have missed out on

Feeding a preterm baby:

• All newborn infants are different when it comes to feeding, whether they were born at term or preterm
• When an infant is in the womb, they receive both nutrients and fluid via the umbilical cord and placenta
• Babies store nutrients in the third trimester of pregnancy, so a preterm baby has minimal stores and therefore it is important they are given the nutrients they need to help achieve catch-up growth
• Preterm babies are fed in a combination of ways depending on their health and maturity
• The aim for feeding preterm babies is to acheive a weight gain at the same rate as if they were still in the womb
• Preterm infants have immature organs and often cannot take feeds by mouth at first and so will need to have total parenteral nutrition (intravenous feeding)

Feeding methods for a preterm baby

Total Parenteral Nutrition (TPN):

• This is used for very preterm or very unwell babies
• This is where all the nutrients your baby needs to grow and thrive are passed directly into their bloodstream rather than using their immature digestive system
• The nutrients are passed into the bloodstream intravenously; it’s very common to use the umbilical vein where a tube is inserted into the belly button
• As your baby grows and gets stronger, they’ll begin tube feeding either via the nose or the mouth

Tube feeding

• Nutrients are passed into the stomach directly through a fine tube placed via the mouth called oro-gastric feeding, or the nose called naso-gastric feeding
• Used because preterm babies often lack the co-ordination of sucking, swallowing and breathing to be able to be fed orally
• Tube feeding is used at first to give small volumes of a feed to preterm infant.  These feedings are known as minimal enteral feedings. It is important to give preterm babies these feeds because it helps with the development of the gut
• It may be possible for parents to help out with tube feeding under the supervision of the nursing staff; this will help you bond with your baby

From tube feeding to breastfeeding:

• It’s a good idea to start expressing your milk as soon and as frequently as possible after the birth of your baby. This breast milk can be frozen and stored for when your baby is ready to take it
• Your baby may open or close their mouth during a tube feed. This is a sign your baby is ready to practise sucking
• If possible, it’s a good idea to have your baby by the breast during tube feeding so that they get skin-to-skin contact.  Babies that have skin-to-skin contact with their parents have been observed to spend less time crying. Also close contact with your baby also stimulates your breasts to make more milk
• It may take several weeks before your baby can breastfeed; this will depend on how preterm they are as well as their age, their medical condition and how strong they are.  Plus, some babies take longer to learn than others. The important thing is to be patient and try not to worry

Benefits of breastfeeding:

• During the third trimester, mothers pass antibodies (that help to fight off infections) through the placenta
• This process is cut short for a preterm baby, leaving them vulnerable to infection, however your baby can get these antibodies through breast milk
• Preterm breast milk is rich in antibodies and growth factors
• Breast milk is also easy to digest and absorb
• Once your preterm infant has established breastfeeding, the skin-to-skin contact will help to build a bond between you and your baby
• Breastfeeding also benefits mums; it has been shown to reduce the risk of postpartum haemorrhages due to the release of the hormone oxytocin which helps to bring the uterus back to its original size
• There is also evidence to show that breastfeeding can help to reduce your risk of breast cancer and ovarian cancer later in life

Supplementary feeding

• If you’ve been ill during pregnancy or if you are having difficulty expressing breast milk, you may have trouble producing all the milk your baby needs
• In this case, you can supplement your baby’s diet with breast milk donated to the hospital by other mums or with a low birthweight formula
• This is a short-term measure, as you should be able to produce enough milk for your baby soon

Fortifying breast milk

• Breast milk is perfectly designed to meet all the nutritional needs of a term, newborn baby
• However, sometimes a preterm baby has more complex needs, particularly if they are born very prematurely
• Breast milk may not provide all the nutrients a preterm baby needs
• In that case, breast milk fortifier with extra protein, vitamins and minerals may be added to your expressed milk.
• This will then be given to your baby by tube feeding
• This is usually only given until your baby is strong enough to feed directly from the breast

From tube feeding to bottle-feeding

• If possible, it’s good to have skin-to-skin contact with your baby while tube feeding and then carry this on if they are bottle-fed
• Your baby may open or close their mouth during a tube feed. This is a sign your baby is ready to practise sucking
• Once your baby is mature enough, staff may give them a dummy to practise and help develop their sucking reflex

Bottle-feeding

• In hospital, preterm babies who aren’t being breastfed may be given a specially-designed formula for low birthweight and preterm infants; these are called low birthweight formulas
• They contain more of the nutrients preterm babies need to help achieve the appropriate growth, including protein, vitamins and minerals, specifically calcium and phosphorus to help with bone development
• Low birthweight formulas are usually given by tube feeding until your baby is mature enough to coordinate sucking, swallowing and breathing then they can begin bottle-feeding
• Once your baby is ready to be discharged from hospital, if they are not already breastfeeding they may be prescribed a post discharge formula
• Post discharge formulas are used to help continue your preterm/low birthweight baby’s catch up growth
• They offer a nutritionally sound transition from the low birthweight formula to formulas for term babies

Weaning

• For babies born at full term, government guidelines recommend they don’t start weaning until 6 months.  However, these guidelines do not include preterm babies
• It is recommended that a preterm baby should start weaning between 5 and 7 months old using their chronological age (from the day your baby is born)
• You don’t have to wean as soon as 5 months arrives, but start to look for signs that your baby is ready, such as:
  
  
  • Your baby can be easily supported in a sitting position
  • They are showing interest in other people eating
  • They are putting things into their mouth
  • They seem less satisfied with milk alone
• It is better to wait until your baby is ready to start weaning, rather than rush into it. A preterm baby’s digestive system may not be developed enough to take solids before 5 months
• It is important that weaning is not delayed too long.  At around 4 months, babies are able to use their mouth to explore food and toys.  Starting solids shortly after these chewing movements begin helps with the development of the mouth and jaw muscles
• At around 5 to 7 months preterm babies are usually willing to try new flavours, however as they get older they may become more reluctant to do this
• For more information on when and how to wean your preterm baby, consult your healthcare professional

For more information and support in looking after your preterm baby visit the website of the preterm charity BLISS at www.bliss.org.uk