Nutrition in premature and sick newborns
Not only are premature babies smaller at birth, but they are also less developed than full-term babies. Therefore, they have more difficulty with vital tasks such as drinking. Even full-term babies with problems may temporarily need an alternative way of feeding.
If your baby does not (completely) tolerate food through the stomach and intestines, we will give her fluids, sugar, proteins, fats, vitamins... through an infusion directly into the bloodstream.
As soon as the gastrointestinal tract is ready, we start with regular food (artificial food or breast milk). At that time your baby may not yet be able to combine breathing, sucking and swallowing to be able to drink by herself. This is usually the case in premature babies born before week 34 of pregnancy. In that case, we use a feeding tube. This tube runs through the nose into the stomach. When feeding through a tube is tolerated, the amount can be gradually increased, while the infusion can be progressively reduced.
If your baby digests the food properly and has a good sucking and swallowing reflex, we start drinking from a bottle (artificial food or breast milk). This is usually possible from the age of 34 weeks of pregnancy. Because drinking is a big effort for babies, in many cases they do not succeed in taking in the necessary amount from the start. Supplementation by gavage may therefore be necessary.
If your baby drinks breast milk, we switch to breastfeeding as soon as possible. This way of drinking is more difficult than bottle-feeding. At the start, therefore, it will often be necessary to add a bottle (mother's milk or artificial milk), but after a while, many babies will only be breastfed.
During the first six months of life, breast milk is the most adapted and natural food for your baby. All her nutritional needs are met and the risk for gastrointestinal disorders, food allergies and infections is lower than with artificial food.
In babies with a low birth weight, it may be necessary to add to the mother's milk to meet the specific needs to catch up with growth. This can only be done by pumping the milk and giving it in a bottle.
Contrary to full-term babies, breastfeeding should be introduced stepwise in premature babies. This requires a lot of effort and perseverance. Patience and love are the key words.
If your baby is between 32 and 34 weeks old, you can start the initiation. The intention is to teach the baby to bite at the nipple. A full-term baby does that spontaneously, but a premature baby has to learn it. It may take a few weeks before she is able to do it smoothly by herself. Give your baby this time.
The most important things to remember are listed below.
- Sit in a well-supported, upright position.
- Use a pillow to support your arm and baby.
- Make sure you and your baby are lying/sitting belly to belly.
- Keep your baby lying sideways with her head and body in a straight line.
- Make use of the bite and search reflex: stimulate the upper lip (not on the mouth) with the nipple, so that the head bends slightly backwards when biting and the nose remains free.
The bite for the nipple is the first step. Keeping the nipple in her mouth and continuing to suck is the second step. A prematurely born baby has a suction pattern in which she sucks and swallows several times in succession before breathing. The baby often lets go of the nipple to breathe.
It's important to teach your baby to bite actively. Therefore, the bottle or pacifier (and nipple) must be presented correctly. Stimulate the upper lip with a teat (or nipple) so that your baby can open her mouth and bite actively. It may be necessary to roll or massage the nipple beforehand. This ensures that the nipple comes out and milk production is stimulated.
It goes without saying that only babies who are in good stable condition can start learning to breastfeed. In the beginning it is practiced once a day and gradually the number of breastfeeding moments will be increased. This gives your baby the chance to learn and grow at her own pace.
More information can be found at the page Breastfeeding.
The choice for breastfeeding is often made during pregnancy. However, your baby may not be able to breastfeed right after birth. In that case, you will have to pump. Pumping requires insight and a lot of patience and can be mentally difficult.
If you opt for artificial milk or if the pumped mother's milk is not sufficient, your paediatrician will prescribe a milk formula that meets your baby's needs. The number of feedings your baby needs per day depends on the baby's weight. This number of feedings determines the feeding times that your midwife will give you. She will also invite you to give the bottle yourself.