Nutrition for Premature Infants in the NICU

For a time, healthcare staff will care for your baby in the neonatal intensive care unit (NICU). There are several ways to feed babies while they’re in the NICU. A healthcare provider may start to feed your baby through an IV (tube that goes into the vein). A tube may be used to send formula or breastmilk into the baby’s stomach (a gavage feeding). Your baby may be able to go directly to breast or bottle feeding. The best method depends on your baby’s health and gestational age. Your baby will likely be feeding from a breast or bottle before leaving the NICU to go home.

What are babies fed in the NICU?

  • Total parenteral nutrition (TPN). This is a solution that provides all the nutrition your baby needs. Your baby gets this through his or her vein. Healthcare providers give TPN to most very early preemies. This is because their digestive systems are not yet mature, so they can’t absorb enough nutrition through regular feedings.

  • Breastmilk. Your baby can get nutrition through pumped breastmilk, with a gavage feeding or with a bottle. Many preemies learn to breastfeed while in the NICU. Ask the NICU staff about the best way to pump and store milk for your baby. If your baby is a preemie, the breastmilk may be mixed with a protein supplement to help your baby’s growth. Breastmilk benefits premature babies because it reduces the chance of getting infections and is easiest to digest.

  • Formula. Special formulas are designed for preemies’ needs. The healthcare team will give this to your baby, with a gavage feeding or a bottle, if you are unable to breastfeed or choose not to. Sometimes it supplements breastmilk.  

How does a baby move from TPN to full breast or bottle-feeding?

If your baby has started on TPN, moving to full breast or bottle-feeding may take 3 to 4 weeks. This depends on your baby’s gestational age. A baby is often able to feed from your breast or a bottle by 32 to 34 weeks gestation. Gavage feeding may be tried first with younger preemies. In any case, the baby is started on a small amount of breastmilk or formula. The amount of breast or formula feedings is increased as the baby grows stronger. At the same time, TPN is decreased. The goal over time is to work up to full feeding. This is often calculated as 150 to180 mL of breastmilk or formula, per kilogram, per day. In some cases, a baby who is having a medical problem may need to go back to TPN for a time. If this happens, breastmilk or formula feeding will be started again when the baby is ready.


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