Not feeding yet?
When your baby is admitted to the NICU and is kept “nil by mouth” she still  needs to get food.  She may not yet be fed milk, because her intestines are not properly developed and in case of stress (like being born prematurely), you do not want to put extra stress on the stomach. In this situation, the most important organs, namely the brain and heart need to be provided with blood that carries oxygen.  However, your baby still needs to receive energy in the form of nutrients and vitamins, which can then be given via a drip or parenteral feeding (TPN).

TPN is a liquid running into the baby’s veins into the bloodstream and then to wherever it is needed.  This liquid can also take many faces.  It may look like water, or if some additional nutrients are added it may have a yellowish or milky colour,  but remember milk can never be given through the veins.  Ask your doctor or the sister what your baby is receiving through the drip.

During this time, it is important for your baby to get opportunities for non-nutritive sucking.  A pacifier is commonly used in NICU’s for this purpose.

How will I know which pacifier to use?

The pacifier used for non-nutritive sucking is very important. It must be the appropriate size and shape to encourage as normal development. Using a pacifier with the correct size and shape will also help fast-track the complex milestone of and maturation of this complex milestone to enhance the transition from tube to oral feeding. Pacifiers that are too short and/or bulbous can encourage abnormal tongue movement. This that can be difficult to overcome during the transition to either breast or bottle feedings. In addition, a soft exterior shield will facilitate positive lip stimulation and enhance proper placement when the baby is either on her side or tummy with the head turned to one side . You get the best results with teats that are round at the front, small and as soft as possible. The mouth guard must be big so that the baby does not swallow it. It must be well shaped to provide stimulation of the lips to further the baby’s suckling reflex.

Choosing a pacifier

A useful guideline is to choose a pacifier that is the size and shape of the baby’s thumb for babies less than 1.2 kg since your baby would be sucking her thumb if she was still in the womb. When she weighs more than 1.2 kg and can suck with coordination, select a pacifier that is as close as possible to the nipple of a breast to promote successful feeding and later speech development. Be careful for any nipple shape that is not cylindrical, since that may prevent the tongue to “cup” around the breast, leading to choking and speech problems.
When bottle-feeding, you can use the same selection criteria and teats with wings can then be used since they encourage lip closing. Feeding of a premature baby is a very important activity, but it is also a very unnatural and stressful event for both parent and baby. Do yourself a favour, ask to see a lactation consultant while you are still in the NICU and do not just blindly follow the guide of friends and family. All babies do not necessarily go the same route. Remember, your baby is a unique little person! In addition, it would serve you well to follow professional advice.

When starting oral feeding (breast- or bottle feeding)breastfeeding, as with bottle-feeding your baby will probably not be able to feed successfully from the start. start with the oral feed one morning and it will be successful.  Changing from tube feed to oral feeds is a process and it can take some time. takes time.  You will probably start of with one oral feed per day and, the tube feeds for the rest of the day.  The frequency of  with the oral feeds will be increased as soon as your baby is able to tolerate it.your baby can tolerate it.  Remember, your baby is a unique person and cannot be compared with any other the baby next door!  The volume of breastfeeds cannot be measured, therefore it is important that you learn to observe your baby and know read about breastfeeding to learn the signs of a baby that is feeding  well. You will use this guideline when going home where you will not have a scale to weigh your baby after each feed (this method of weighing a baby before and after a feed do not always prove to be effective).

Breastfeeding supports the baby by maintaining appropriate thermoregulation, reducing the risk of infection and guaranteeing optimal nutrition and brain growth. It benefits the mother as well by reducing the separation between mother and child, promoting attachment and reducing fertility.

Advantages of Breastfeeding
Breast milk is the feed of choice, even for preterm infants as it contains all the necessary beneficial fats that a premature baby will need to , which improve brain and eye development.  It also, it contains immune factors, which protect the infant against infections and it protects against food allergies in most cases.  Breastfeeding have advantages for baby and for the mother.  The advantages for the baby include the following:

Advantages for baby

• Mother’s milk contains all the nutrient baby needs, enhancing optimum growth and development
• It is easily digested and fully absorbed by the immature digestive and excretory systems, causing less colic and diarrhoea and prevents constipation
• It contains antibodies and living cells, which provide protection and immunity to many infections, such as viral infections – polio and respiratory tract, ear and intestinal infections. Anti-bodies produced by mom are transferred to baby via the breast milk to protect the baby.
• Breast milk contains unique proteins and fats which stimulate brain development
• It lowers the risk of allergies, such as eczema and asthma, since breast milk is a natural body fluid and provides protection
• Less nappy rash and thrush
• It is constantly available at the right temperature and cannot be contaminated
• Breast milk cannot be prepared incorrectly
• Breast feeding promotes proper mouth, jaw and teeth development

Advantages for mom

• Oxytocin is released when you breastfeed, causing the uterus to contract, minimizing bleeding, decrease infection and returning the uterus to its pre-pregnant state faster
• A quicker return of the pre-pregnant figure as milk production consumes calories – follow a balanced diet and healthy lifestyle
• Promotes bonding with your baby, emotional satisfaction and a feeling of well-being
• Breast feeding decreases risk of pre-menopausal breast cancer
• It is convenient and readily available, requires less preparation and equipment, and makes socialising and travelling easier
• Breast feeding is very economical

Chapter seven of Prematurity – Adjusting your Dream explain breastfeeding in detail and give much needed attention to the development of feeding in the preterm infant, the special advantages and adaptations of preterm milk, how to position the premmie for feeding and discuss winding .

When bottle-feeding, you can use the same selection criteria  for choosing a pacifier when you need to decide which bottle to use.  The teat should be peristaltic so that if shapes in the baby’s mouth as she sucks on it..  Teatsand teats with wings can also then be used since they encourage lip closing.  Since all babies are unique, it is very difficult to prescribe a specific brand of bottle to use.  When deciding on what bottle to buy, rather use the following guidelines than opting for a specific brand that has worked for another baby.

When choosing a bottle, take the following into consideration:

• The bottle should be Bisphenol-A (BPA) free.  BPA is an chemical that has been used for many years in the manufacturing of hard plastic containers, and has been known to be toxic.
• The teat of the bottle should be peristaltic.
• The measurements indicator of the bottle should not be printed as this can be easily washed off.  Bottles with the measurement indicators moulded on the outside of the bottle is preferred.

Feeding of a premature baby is a very important activity, but it is also a very unnatural and stressful event for both parent and baby. Do yourself a favour, ask to see a lactation consultant while you are still in the NICU and do not just blindly follow the guide of friends and family.  All babies do not necessarily go the same route.  Remember, your baby is a unique little person! In addition, it would serve you well to follow professional advice.