Things to Note When Feeding a Preterm Infant?

Things to Note When Feeding a Preterm Infant

Preterm infants need to have the best nourishment possible due to their extra nutritional requirements. These infants are born before the healthy 37-week mark, so their organs have not developed fully, resulting in the need for extra nutrition.

The diet has to be matched with that received while inside the womb. Hence, it is important to closely monitor the premature baby to give them the best care there is for their healthy progression. This monitoring is done when the baby is admitted to the special neonatal intensive care unit (NICU) where the baby’s diet and health are closely paid attention to.

The babies are placed in incubators, which are used to keep the child warm and maintain the same temperature as the womb. This prevents premature children from using too much of their energy to keep themselves warm. The incubator also keeps the air around the child moist so that they don’t lose any moisture and get dehydrated.

Before we explore some of the ways neonates are fed, we need to look at some of the problems they may incur at birth, preventing them from being fed properly.

What Feeding Issues Can Occur in Premature Infants?

Although the best nutrition is given to the infant through breast milk, there are instances where the infant can face problems in feeding on the breast or a bottle. Since preterm infants have not properly developed, they find it difficult to coordinate the functions of sucking, breathing, and swallowing.

Other underlying health problems can also contribute to the child not being able to feed as required. These illnesses include:

  • Respiratory illnesses
  • Decreased oxygen
  • Circulatory issues
  • Infections in the blood

As premature infants are prone to such illnesses, they will have problems in feeding as compared to children born within the normal gestation period. Due to this, many premature babies are given nutrition in intravenous form. An IV is placed in their arms to supply them with necessary fluids and nutrients.

What Are the Nutritional Needs of Premature Infants?

The nutritional needs of premature infants are higher as compared to full-term infants because of their poorly developed bodies.

The kidneys are in charge of maintaining healthy water levels in the body, but in preterm infants, they are not developed properly and cannot perform their functions of excretion and balance. As a result, neonates find it difficult to maintain a healthy balance of water in their bodies.

For very premature children, there can be issues of dehydration or overhydration. They are more likely to lose water through their skin and respiratory tract as their skin barriers and organs are not fully developed yet. This can increase the risk of dehydration occurring.

The intensive care unit is equipped for monitoring water levels by tracking urine. The infants’ diapers are weighed to ensure their water and urine levels are balanced. Furthermore, their electrolytes are tracked by performing regular blood tests to prevent any imbalance which can be potentially life-threatening for the infant.

Preterm infants also have additional nutritional needs because they have spent less time in the womb to accumulate the essential nutrients. As these infants are not able to feed properly, they may need a supplementary feed alongside breast milk. This feed will include higher levels of calories, vitamins and other nutrients such as proteins, iron, calcium, vitamins A, D, C and D, and folic acid.

For some children, extra supplements will be a necessity in their diet. As they are born premature, they can suffer from deficiencies and will need iron and vitamin D along with breast milk. This may also include some children who cannot obtain all required nutrients from breastfeeding alone.

With the extra supplements, the baby should seem sated and comfortable. Any abnormal changes such as irregular bowel movements or vomiting should be reported to medical professionals.

What Is Supplementary Milk Formula for Premature Infants?

Breast milk is recommended for preterm infants as it the healthiest option and provides the most nutrients. This milk contains nutrients and antibodies which can protect the infant from life-threatening viruses. The possibility of severe eczema, obesity, and even sudden death is greatly reduced through breast milk. Breastfeeding is helpful not only for the baby but also for the mother as it protects her from illnesses such as breast and ovarian cancer.

However, there are times when breast milk is not an option. For instance, the mother may not be producing milk or the baby may be too premature to breastfeed. When breast milk is not enough, neonatal milk powder is prescribed.

For the development of premature infants, the milk powder must contain special ingredients. Fatty acids such as docosahexaenoic acid (DHA) and arachidonic acid (ARA) have to be added. The purpose of this milk powder is to help the premature infant reach a healthy weight of 4-5 kg and attain the nutrients they missed out on from early birth.

Premature infants require additional nutrients and calories. Due to a high metabolism, they require around 150 kcal/kg/day. Furthermore, the daily protein requirement is 4.0 g/kg/day. There is a chance of hypophosphatemia if the children are only fed breast milk when their birth weight is very low. Therefore, it is recommended to use a formula that contains at least 81 kcal, 2.2 g of protein, and 45 g of fat per 100 ml of milk. This formula will be lighter on the digestive system while providing the correct amount of nutrients. Doctors also take note of the osmotic pressure and supply 60-70% of glucose to encourage healthy development.

The special formula milk is only given for 20-30 days. When the baby’s weight reaches 2500 grams, the premature infant milk formula is replaced with regular baby milk formula. This is because excess nutrients can also pose a problem for the baby, just like deficiencies can. This transition from premature infant milk formula to regular infant milk powder must be done gradually with controlled addition of the latter.

Since premature infants suffer from weak gastrointestinal functions, any sudden changes in their diet can lead to a gastric reaction. Therefore, when they are introduced to regular milk formula, it should be gradually added into their premature infant milk formula. During this stage, the infant should be closely monitored for any changes in their stool. If any abnormality is observed, doctors should be contacted for further checkups.

How Easy Is It to Obtain Premature Baby Formula?

Although premature infants make up only a small proportion of the population, there is still a market for the provision of special premature milk formula. In China, this special formula is available, but all the brands are imported. The demand for this product is very low and takes up a lot of resources to produce domestically and as a result, it is not available in the same amount as regular baby milk formula.

The supplementary milk formula for preterm babies is made from special and high-quality raw materials, must abide by strict health standards, and should be moderately priced. Along with meeting the strict health standards, production companies need to conduct clinical trials which can increase the cost of production up to 1 million yuan. As a result, China does not produce premature infant milk formula.


Premature children need extra care at all levels due to their special circumstances. It is important to take note of their nutritional needs as they could not take advantage of the gestational period and were unable to gain the nutrients required in the womb.

The womb gives babies protection from illnesses and diseases and provides nutrients that aid in the development of the baby’s organs and necessary functions. However, when the baby is born before the 37-week mark, various problems can occur. At times, premature children have to be fed through their veins via a feeding tube that is directly attached to their abdomen. This tube supplies special infant milk formula.

Premature baby milk powder also ensures the child reaches their healthy weight. This healthy weight is between 4 and 5 kg. During this time, the nutrients in this special formula help the baby’s organs develop, especially the gastrointestinal functions. After the recommended weight is achieved, normal baby milk formula can be added to the premature infant milk for gradual replacement.

Care must be taken when replacing the special premature formula with regular milk formula to prevent any sudden changes in the body. There is no need to worry, though. Your medical professionals will guide you on all the necessary points regarding feeding, including the recommended brand of milk formula. The premature baby will be handled with care and monitored at all times. Thus, it is best to leave the main job to your doctors and you can focus on helping your baby make a quick recovery.

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