Premature infants have special nutritional needs that depend on their gestational age and health status. They may be fed intravenously through total parenteral nutrition, through a feeding tube via gavage, or directly by mouth once they can coordinate sucking and swallowing. The goal is to meet their nutritional requirements to support growth and development while avoiding feeding-related health issues like necrotizing enterocolitis. Feeding methods transition over time from intravenous to enteral as the infant's maturity and ability to tolerate feedings improves.

1. NUTRITION
FEEDING PREMATURE INFANT
BY: MANISHA SHARMA
NURSING TUTOR

2. Introduction
• Preterm is defined as babies born alive before
37 weeks of pregnancy are completed. There
are sub-categories of preterm birth, based on
gestational age: extremely preterm (less than
28 weeks) very preterm (28 to 32 weeks)
moderate to late preterm (32 to 37 weeks).

3. Key points
• Premature babies may be fed intravenously,
through a feeding tube or directly by mouth.
• How and what a premature baby is fed
depends on their gestational age and
complications with any part of their GI tract.

4. Objectives
• Meeting the recognised nutritional
requirements of the preterm infant.
• Achieving an acceptable standard of short
term growth.
• Preventing feeding-related morbidities,
especially necrotising enterocolitis (NEC).
• Optimising long-term outcomes

5. Indications
• Evidence supports early enteral feeding.
• Stable infants of any gestation, with no
contraindications, should commence enteral
feeding as close to birth as possible (7).
• If feeding contraindicated/feeding intolerance,
colostrum should be used buccally as mouth care
(see below).
• Regular assessment should be undertaken for
evidence of any feed intolerance, particularly
“high risk”:

6. Nutritional requirements
Nutrient Term infant
Preterm infant Tsang 2005 Preterm
infant 1-1.8kg
ESPGHAN
2010
ELBW (<1kg) VLBW (1-1.5kg)
Energy (Kcal/kg) 95 -115 130-150 110-130 110 -135
Protein (g/kg) 2 3.8-4.4 3.4-4.2 4.0 – 4.5 (<1kg)
3.5 – 4.0 (1-1.8kg)
Sodium
(mmol/kg) *
1.5 3.0-5.0 3.0-5.0 3.0 – 5.0
Potassium
(mmol/kg)
3.4 2.0-3.0 2.0-3.0 2.0 – 3.5
Calcium
(mmol/Kg)
3.8 2.5-5.5 2.5-5.5 3.0 – 3.5
Phosphate
(mmol/kg)
2.1 2.0-4.5 2.0-4.5 1.9 – 2.9

7. Types of feeding
There are three ways to feed premature
babies: intravenously, through a feeding tube,
and directly by mouth. They may receive three
different kinds of nutrition: total parenteral
nutrition (TPN), breast milk, and infant
formula designed for premature babies. How
and what a premature baby is fed depends on
their gestational age and whether there are
complications with any part of the
gastrointestinal tract.

8. Intravenous feeding and parenteral
nutrition
• Although even the most premature gut is
capable of accepting and digesting milk,
sometimes the baby may be too unwell to be
fed this way. In such cases, premature babies
are fed in a way that bypasses the digestive
system altogether and delivers nutrition
directly to the baby’s bloodstream through an
intravenous line (IV) or a catheter.

9. Through this line, a premature baby is initially fed
sugar water with essential electrolytes for a few
days, followed by a solution called total parenteral
nutrition (TPN). Made up of proteins, vitamins,
minerals, sugar, fat and water, TPN feeding may go
on for days or weeks depending on the maturity of
the baby and their ability to feed in an alternative
way.

10. When to stop TPN and remove
intravenous/Central lines
• For babies born before 28+0 weeks, consider stopping
parenteral nutrition within 24 hours once the enteral
feed volume is 140 to 150 ml/kg/day.
• For preterm babies born at or after 28+0 weeks,
consider stopping parenteral nutrition within 24 hours
if the enteral feed volume tolerated is 120 to 140
ml/kg/day.
• Locally we have agreed that, to minimise infection risk,
removal of lines may be considered once an infant is
making good progress with feed advancements and
has reached an intake of at least 120ml/kg/day of
feeds.

11. Gavage feeding
Once the premature baby is stable enough to
receive feeding through the gut, they can be
given gavage or nasogastric (NG) feedings. A
small tube is inserted through the nose or
mouth and run directly into the baby’s
stomach. Small amounts of expressed breast
milk or formula are then gently allowed to
flow into the stomach. If the baby handles
these feedings, they are fed progressively
larger quantities.

12. Breastfeeding and bottle feeding
• Once the baby has developed the co-ordination
to begin sucking and swallowing, the team will
make an effort to help the parents with breast
feeding. Most mothers are encouraged to pump
their milk right away so that the flow of milk
begins and continues. Pumped breast milk can be
given to the baby when they are ready for either
gavage, breastfeeding or bottle feeding. Many
parents have a great desire to feed their child
themselves, which enhances their parenting role
and helps with the bonding process.