Nutrition in the NICU

Nutrition is a very important part of a baby’s development by providing the building blocks for growth and brain development. Nutrition also helps babies fight and resist infections. Premature infants are especially at risk for poor growth and infections due to their immature organ systems and smaller-than-normal amounts of muscle and fat. Because nutrition is so vital to a baby’s growth and development, CHOC Children’s has dedicated registered dietitians who are an essential part of each newborn’s health care team.

NICU Dietitians

The registered dietitians in our NICU have advanced training in pediatric nutrition, lactation education and specialized nutrition support. Our dietitians work closely with members of our health care team—including the physicians, bedside nurses, nurse practitioners, developmental/feeding therapists and pharmacists—to provide the very best medical nutrition therapy to our patients. Our dietitians evaluate and monitor our patients throughout their hospitalization in order to optimize each nutrition care plan. As needed, the plans are modified to ensure the best possible nutrition outcomes for our babies. As the babies are ready to be discharged, our dietitians educate families on continuing good nutrition at home.

Developing Special Nutrition for Premature or Sick Babies

All NICU patients are unique and so are their nutritional needs. In the first few days of life, a premature baby’s stomach and intestines may not be ready for any feedings and will require IV (intravenous) fluids as a source of water and calories (energy). This fluid is needed to keep the baby hydrated, blood sugars stable and to prevent excessive weight loss after birth. These customized solutions are made by our pharmacy and have sugar water or dextrose and may contain protein and some minerals (electrolytes) as needed.

Because babies need good nutrition very early, a solution called Total Parenteral Nutrition (TPN) soon replaces the IV. TPN is a mixture of sugar water (dextrose), protein, vitamins and minerals specially made for each baby’s unique needs by our pharmacy. Babies also receive another solution, called Intralipid (IL), which is a special form of fat that goes directly into the body as an IV and provides the baby needed calories or energy. Over several days, the TPN and IL solutions will be increased to ultimately meet the baby’s nutritional needs.

When the medical team decides a baby is ready to try food, the baby may not be ready to take this nutrition by mouth. Most babies cannot organize breathing, sucking and swallowing until they are around 33 to 34 weeks gestation. Some babies may be too sick or be breathing too fast to drink from a bottle or breast.  When this is the case, a very small tube is passed through the nose or mouth and into the baby’s stomach. The NICU has created feeding guidelines based on the birth weight of the baby to provide a successful “road map” from very small “trophic” (stimulation feedings) through “advancement” (full volume) feedings.   Feedings are given every few hours or by a constant slow drip into the stomach. As the feedings begin to slowly increase in volume, the TPN will be slowly decreased. It is not uncommon for there to be changes and adjustments to feedings as a baby’s needs change and his or her body learns how to handle food. For the smallest babies, a feeding guideline may take up to three or four weeks to get to full feeding volumes.

Breast Milk—the Preferred Feeding for Babies

Regardless of whether a baby will be in the NICU for a few days or for several months, we encourage all mothers to breastfeed or pump. Providing breast milk is one of the most important things mothers can do for their babies. Babies in the NICU need the “medicine” provided by mother’s milk. Your milk is one of a kind and has special proteins that build your baby’s immune system, fight infection and optimize brain growth. Human milk is specifically designed for human babies: the fats, sugars and proteins are custom fit to your baby’s needs. Mothers of premature babies actually make milk that is different than full-term milk. Preemie mother’s milk is initially richer in proteins as nature tries to meet the need for extra protein. Breast milk is the easiest milk for a baby to digest. This is especially important because babies that arrive early have immature digestive systems.

It is for all these reasons and more that our doctors and the NICU team encourage you to provide breast milk for your baby. (Some babies will meet criteria for donor breast milk, a specialty program offered for our very low birth weight babies.) Because premature babies most often need additional calories, minerals and protein, a liquid called “Human Milk Fortifier” will be added to your milk. This is meant to maximize growth, promote weight gain and strengthen bones.

Specialty Formulas in the NICU

Under certain circumstances, a baby may not be able to digest and absorb breast milk and may require a special infant formula. Our NICU provides all commercially available formulas and is able to create unique “recipes” that match each baby’s need. Upon discharge from the NICU, our dietitians will teach you how to prepare and purchase formulas at home.

Lactation Consultants, By Your Side

Many of our moms have learned of the benefits of breastfeeding and breastmilk, especially for their ill infant and choose to breastfeed their babies. The NICU has Certified Lactation Consultants to help you with your questions and concerns.

Learn more about the lactation services available to you while your baby is at CHOC.

More about Breastfeeding

Nursing mothers are providing their babies with nutrients to help ensure their growth – but what about mom’s diet? Learn about the need for extra calories and what foods to be mindful about in this CHOC Radio podcast.

Parents of premature infants face many new challenges as they help their special infant grow and flourish, and breastfeeding is often one of them. Learn how to meet a preemie's nutritional needs in this blog post.

CHOC Children’s is seeing fewer breast milk feeding errors after a more than two-year initiative to redesign the process for safer and more efficient handling. Learn more in this blog post.