The Nutritional Needs of Premature Babies

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The nutritional needs of preemies generally fall into two categories: delivering nutrition to the baby and making sure there are enough calories for body and brain development.

Every Calorie Counts

"Even healthy preterm infants have more nutritional needs than term babies," says Dr. Eric Reynolds, a neonatologist at the Kentucky Children's Hospital. "Whereas most term babies require about 85 to 100 calories per kilogram of body weight, preterm infants often require greater than 120 calories per kilogram per day."

Much of this need for extra calories is to play "catch up" and get the baby to a healthier height and weight, but there are other reasons as well. "The preterm gut is less efficient when it comes to absorption of nutrition, so the baby must take in more calories from feeds in order to get the required nutrients into the body," says Dr. Reynolds. He also explains that infections or illnesses may put extra stress on the baby's body, causing it to work extra hard at tasks like breathing, and thus burning additional calories.

Likewise, a premature infant has not had as long to accumulate a store of nutrients. "A premature infant will need additional supplementation of the milk they consume—whether it is breast milk or formula," says Dr. Ann L. Anderson Berry, a neonatologist and an assistant professor of pediatrics at the University of Nebraska Medical School. "These demands include increased need for protein, calcium, sodium, phosphorus, and calories, to name a few."

Delivering the Nutrition

For those calories to make a difference to the well-being of a preterm infant, they have to make their way into the baby's body. This is often not a simple task. "In order for a baby to feed efficiently, he must be able to coordinate sucking, swallowing, and breathing," says Dr. Reynolds. "This is the most complicated thing a newborn baby must accomplish to achieve independent survival."

When DeAnna Starn of Toledo, Ohio, gave birth to son Nicolas at 33 weeks, doctors and nurses dubbed him a "feeder and grower," meaning that the only thing they were watching him for was learning to eat on his own (waiting for the sucking reflex to kick in). The hospital allowed Starn to try bottle feeding only once a day, not wanting to stress out the infant. Feedings were otherwise done via gavages (tubes) while he sucked on a pacifier. When the baby finally drank a full feeding, a plan kicked in that Starn likens to marathon training. "The idea was to gradually introduce bottles, adding one more each day," she says. "Bottle feedings were spaced out to reduce stress and allow the kiddo to rest up. If for some reason he didn't finish one of the feedings, the plan put him back a day."

Other feeding issues preemies may deal with can also require a good deal of patience. Parents may find it challenging to keep their preemie awake long enough to consume a sufficient amount of food. Since some preemies have lingering respiratory issues, parents may need to be shown by staff how to handle medical equipment and how to properly position the baby during feedings. Trouble latching on, reflux and vomiting, and achieving enough stability to come out of the incubator to attempt breast or bottle feeding are also common dilemmas.

Moving to Solids

Just like the parents of full-term babies, parents of preemies often wonder when they should begin to introduce solid food into their child's diet. Kylie Hagemann, a clinical dietitian with Methodist Dallas Medical Center, says the time a premature baby is ready for solid foods depends on the baby. "With term infants, solid food is usually started around 4 months," he says. "With premature infants, parents can start trying to introduce solid foods at the mid-point between four months after birth date and four months after due date. Most babies are definitely ready to start solid foods by seven months after birth date."

Hagemann suggests looking for cues that the baby is ready, which include the following:

• Having the ability to sit up and hold his head up well
• Leaning toward food when offered and opening his mouth
• Not pushing food out of his mouth immediately (tongue thrusting)

Also, as with term infants, Hagemann recommends trying one food at a time to monitor tolerance. To ensure the baby is still receiving enough nutrition while trying new foods, Hagemann suggests that beginners breast- or formula-feed first and then be offered solids.

How to Tell If All Is Well

Bringing an infant in for regular medical checkups is obviously an essential step in ensuring preemie's health (and easing a worried parent's mind). But caretakers also can do some monitoring of their own. "The first and foremost way to determine if a premature baby is receiving the proper nutrition is to look for growth in weight, head size, and length," says Dr. Lucky Jain of Children's Healthcare of Atlanta. Dr. Jain also recommends that parents be on the lookout for diarrhea (a possible sign that some nutritional elements are not being digested properly), blood in the stool (a possible sign of protein intolerance), or the child appearing to be hungry more often than usual.

Another thing to remember: Until babies start being born with an owner's manual, there isn't such a thing as a dumb question. Utilize the doctors, nurses, lactation consultants, and other professionals at your disposal. They have the same goal as you—giving your preemie the best possible shot at a story with a great ending!