Northside Hospital - Special Beginnings

FEEDING AND NUTRITION If your baby is unable to receive nourishment by mouth, your baby will receive nourishment by vein (IV). At first your baby will receive mainly sugar water for calories. Within a few days, he may be started on total parenteral nutrition (TPN or “hyperal”). With TPN, protein, fat, sugar, vitamins and minerals are added to the fluids that the baby receives by vein. Your baby can receive complete nutrition and grow on TPN alone. As your baby tolerates milk feedings, the TPN will be decreased. Your baby may be started on gavage (tube) feedings . A tube is passed through the mouth (OG tube) or the nose (NG tube) into your baby’s stomach. Milk is put through the tube. This may be as a constant slow drip, called continuous drip feeds, or as prescribed amounts given every few hours, called bolus feeds. Either way, the amount will be very small at first and gradually increase. There is often a transition period where the amount of nutrition from TPN slowly decreases as the amount from tube feeding increases. Almost all babies lose weight before they begin to gain weight. This weight loss typically is 5-15% of the baby’s birth weight. Sometimes very sick babies gain weight the first few days. This is not real weight gain; it is retention of water. Usually babies do not regain their birth weight until two or more weeks of age. Beginning feeding by breast or bottle When babies are born prematurely their sucking is not well coordinated with their breathing. This suck-swallow-breathe pattern usually becomes coordinated enough to safely breast or bottle-feed at about 34 weeks of gestation. Before your baby is ready to feed by breast or bottle, he may enjoy sucking. A pacifier may be used to encourage sucking. When the baby is being tube fed, he may like to suck on a pacifier or the breast that is empty of milk. This is called non-nutritive sucking. Based on your baby’s feeding cues , the doctors and nurses will determine when to start non-nutritive feedings. At first your baby may have only one or two feedings a day that are not by tube. This will gradually increase as the baby gets used to the extra work of feeding. Babies who have had severe respiratory problems may be slower to start and slower to advance on feedings.

Cues that your baby is ready to feed (cue based feeding) Prior to a feeding they should: • Be awake. • Hold their body in a flexed position with arms/hands at midline. • Demonstrate energy for feeding by maintaining good muscle tone and flexion. • Search for nipple or opens mouth promptly when lips are stroked and the tongue drops to receive the nipple.

As difficult as it may be, if your baby is not showing all of these cues at feeding time, it is better for your baby to be held skin-to-skin during the gavage feeding than attempt a bottle or breastfeeding.

16 Special Beginnings in the Special Care Nurseries