NURTURE INFORMATION HUB
Early Versus Late Parenteral Nutrition in Very Low Birthweight Neonates
A retrospective study from Oman. Amitha R Aroor,1,* Lalitha Krishnan,3 Zenaida Reyes,1 Muhammed Fazallulah,1 Masood Ahmed,1 Ashfaq A Khan,1 and Yahya Al-Farsi2
Advances in Knowledge:
Premature and very low birthweight babies usually receive parenteral nutrition (PN or also known as TPN Total Parenteral Nutrition in the first few days or weeks of being born. PN is intravenous administration of nutrition. The Colour of this is usually white and may include protein, carbohydrate, fat, minerals and electrolytes, vitamins and other trace elements for premature or sick babies all these nutrients in the PN are adjusted to your baby’s latest blood work. PN is a method of feeding that bypasses the gastrointestinal track. Breast Milk and formula could also be provided through a tube feed through the mouth or nose direct to your baby’s stomach. Some call this Enteral Nutrition.They can be given both at the same time until your baby is tolerating feeding.
PN is a common IV administration to premature or sick babies that are born really early and very small and need that extra help to put weight on. It can be used when a baby is critically ill too, at times giving mum time to heal after a difficult delivery. This is all part of the premature and sick baby journey and is there to support your baby until they can tolerate feeds on their own successfully. Knowing more about your babies’ care will help you feel empowered and give you more confidence when you are discussing your babies condition with your baby’s health care team.
Generally, a premature baby’s digestive system is ready for milk feeds before they are actually able to coordinate all the muscles needed for sucking, swallowing and breathing.
In order to receive the milk, a small thin tube called a naso-gastric tube (NG tube) is passed through their nose or mouth, and down into their stomach. Your baby’s feed can then be pushed down the tube with a syringe or sometimes an electric pump may be used to continuously push the milk down.
“My first miracle baby was tube fed for the first seven days with my expressed breast milk. On day seven, I was allowed to see if he could cope with small feeds and he did amazingly. Expressing for the first time was awkward. I had a great supply but it didn't feel right; there should have been a baby on the end of my bosom.” – Linda, Miracle Mum to Zaclan born at 39+3 weeks and Dylan born at 32 weeks
A baby born prematurely may sometimes benefit from receiving expressed breast milk with a milk fortifier. A commercially prepared breast milk fortifier is a powder made from processed cows’ milk protein with additional supplements. When combined with breast milk, the fortifier provides additional energy, protein, minerals and vitamins to help your baby grow more quickly.
By the time your baby is ready for discharge, they should be feeding completely at the breast or bottle, and growing well enough that they no longer require additional milk fortifiers. Your baby’s doctor or dietician will let you know if you still need to add fortifiers once your baby comes home.
Premature babies need time to grow, gain strength and learn to coordinate their sucking, swallowing and breathing effectively. They may spend some days or weeks receiving their milk through a naso-gastric tube before they are ready to try nursing at the breast.
Just like expressing breast feeding is a skill so if it doesn’t work out the first time you try, don’t get discouraged. With a little patience and perseverance, you will learn how to establish breast feeding together.
“Breastfeeding wasn’t as easy as I had imagined, which also made me feel very down. As my baby Harmony grew bigger and stronger, it became a little easier and with the help of some motilium, I managed four months of combined formula and breastfeeding. My advice to new mums is don't be afraid to ask for help; it wasn't until two weeks after Harmony’s birth that a midwife gave me advice on expressing and medication to assist with milk flow. I wish I’d asked for help earlier.”
– Daniela, Miracle Mum to Harmony born at 34 weeks
If you decide to bottle feed, your baby’s healthcare team will be helpful in deciding when they are ready to try a bottle for the first time. Just as with breast feeding, premature babies need time to grow and gain strength and learn to coordinate their sucking, swallowing and breathing effectively.
It’s important to remember that during a feed a premature baby may be sleepy or tire easily and can need more time and patience during a feed. The more bottle feeds you give your baby, the more comfortable you will both be and the better your baby will feed.
Although breast milk is the best nutritional choice for your baby, breastfeeding may not always be possible. If you have chosen to formula feed, your baby will receive formula developed for their nutritional needs. Premature babies usually require formula that contains higher levels of iron, fat, protein, calcium, phosphorous, magnesium and several other vitamins. These special formulas help your baby to grow faster. Your team of health professionals will recommend the most appropriate one for your baby.
“I expressed for five weeks but I found that the stress of that, plus having my baby in hospital, was just too much so I decided to switch to formula. The nurses were super supportive and their ‘you do what is right for you, you have too many other things to worry about’ attitude was so helpful.” – Carly, Miracle Mum to Finley born at 28+5 weeks