Topic Overview

If your premature infant was born before the gestational age of 32 to 34 weeks, he or she cannot feed by mouth. This is because of:

• Poor coordination (or lack) of sucking, swallowing, and gag reflex.
• Weakness of both the oral and stomach muscles.
• Small stomach capacity.

Until your infant becomes stronger and more mature, tube feeding is used to feed milk, formula, or a combination of the two directly into the stomach. For the infant whose gastrointestinal tract cannot yet digest properly or is affected by necrotizing enterocolitis, intravenous (parenteral) feedings are given through a tube into the umbilical site (umbilical catheter) or into a vein.

When your infant is mature enough to feed from a nipple, oral feedings are introduced. Over a period of days or weeks, you can gradually replace more tube or IV feedings with breastfeedings.

Premature infants, including those born at 34 to almost 37 weeks, often have trouble with oral feedings and may need extra help.

In some cases, doctors advise adding a thickening agent to a baby's milk. Talk to your doctor about the risks and benefits before using one. If at any time you are having trouble feeding your baby, talk to your doctor or nurse about it.

Breastfeeding your premature baby

Your infant will probably need to start slowly with breastfeeding. Usually, one or two breastfeedings a day are enough to start. As your baby gains strength and weight, you can start to feed from the breast more often. When your baby is stronger, try to feed your baby directly at the breast for all feedings. If needed, you can use a syringe, cup, or other device to feed breast milk to your baby.

Premature infants can have trouble learning to breastfeed. If you find yourself feeling frustrated or worried about it, get help. Both the nurses and your lactation consultant have years of experience with feeding problems.

As your infant feeds more by mouth, you may not be there for all of your baby's oral feedings. So your infant may need to bottle-feed too. Work with the nurses and lactation consultant to decide whether and when to introduce a bottle.

If you are undecided about breastfeeding, consider keeping your options open. You can pump to keep your milk supply going until you've had time to decide. Any amount of breast milk offers your premature infant greater protection from infection than no breast milk at all. But keep in mind that anything you put in your body can be passed to your baby in breast milk. If you are breastfeeding, do not drink alcohol or take drugs. And before you take any kind of medicine, herb, or vitamin, ask your doctor if it is safe.

In some cases, your health care team may suggest that you use donated breast milk from an accredited milk bank. To find out more about this, including how much it costs, talk with your doctor, nurse, or lactation consultant.

Pumping milk

Regular pumping keeps up your milk production for when your infant is ready to breastfeed. You may also need to pump your breast milk so that your baby has it for tube-feedings. If your infant can't digest milk yet and needs intravenous feedings, your milk will be frozen for future use.

While you are still in the hospital, talk to a lactation consultant and become familiar with the double electric breast pump.

Like most new things, pumping for your infant will get easier with practice. Pump as often as your infant feeds, about every 2 to 3 hours, and at least once at night. Bring your labelled bottles or bags of milk with you to feed your infant or to freeze for later use.

Benefits of breast milk

Breast milk has proven benefits, especially for the fragile premature infant. Benefits of breast milk over formula include better immunity to dangerous infections, nutrient absorption, digestive function, and nervous system development. So your hospital is likely to strongly encourage you to provide breast milk for your infant during the first weeks of life, at a minimum. A lactation consultant can be very helpful with pumping and breastfeeding questions and problems, both before and after the birth.

Using formula

There are formulas made just for premature infants. They provide most of the nutrients your baby needs. Soy protein-based formulas aren't recommended for premature infants.^{footnote 1}

A premature infant has higher-than-usual energy demands on his or her system after birth. No matter how your baby is fed, he or she may need a high-calorie supplement to get the best growth and healing.