Nutrition in the NICU

Nutrition is a very important part of a baby’s development. It provides the building blocks for growth and brain development. Nutrition also helps babies fight and resist infections.

Premature infants are especially at risk for poor growth and infections due to their immature organ systems and smaller-than-normal amounts of muscle and fat. Because nutrition is so vital to a baby’s growth and development, CHOC has dedicated registered dietitians who are an essential part of each newborn’s health care team.

Registered Dietitians

The registered dietitians and in our NICU have advanced training in pediatric nutrition, lactation education and specialized nutrition support. Our dietitians work closely with members of our health care team—including the physicians, bedside nurses, nurse practitioners, developmental/feeding therapists and pharmacists—to provide the very best medical nutrition therapy to our patients.

Our dietitians evaluate and monitor our patients throughout their hospitalization in order to optimize each nutrition care plan. As needed, the plans are modified to ensure the best possible nutrition outcomes for our babies. As the babies are ready to be discharged, our dietitians educate families on continuing good nutrition at home.

Lactation Consultants

Many of our moms have learned of the benefits of breastfeeding and breastmilk, especially for their ill infant, and choose to breastfeed their babies. The NICU has certified lactation consultants to help you with your questions and concerns.

Learn more about the lactation services available to you while your baby is at CHOC.

Feeding your baby in the NICU

Breastfeeding, pumping, and human milk

Regardless of whether a baby will be in the NICU for a few days or for several months, we encourage all mothers to breastfeed or pump. If a mother is able to, providing breast milk can be a wonderful way to provide your baby with optimal nutrients and special proteins that build your baby’s immune system, fight infection and optimize brain growth.

Human milk has the appropriate ratio of fats, sugars and proteins that are custom fit to your baby’s needs. Mothers of premature babies make milk that is different than full-term milk. Preemie mother’s milk is initially richer in proteins as nature tries to meet the need for extra protein. Breast milk is also the easiest milk for a baby to digest, which can be specially important for babies that arrive early and have immature digestive systems.

If a mother is unable to breastfeed, some babies will meet criteria for donor breast milk, a specialty program offered for our very low birth weight babies. Because premature babies most often need additional calories, minerals and protein, a liquid called “Human Milk Fortifier” are added to human milk after expression. This is meant to maximize growth, promote weight gain and strengthen bones.

Specialty formulas in the NICU

Under certain circumstances, a baby may not be able to digest and absorb breast milk and may require a special infant formula. Our NICU provides all commercially available formulas and is able to create unique “recipes” that match each baby’s need. Upon discharge from the NICU, our dietitians will teach you how to prepare and purchase formulas at home.

Developing special nutrition for premature or sick babies

All NICU patients are unique and so are their nutritional needs. NICU babies may go through several steps of feeding and nutrition, and receive specially prepared solutions made by the CHOC pharmacy until they are ready to digest normal breast milk or formulas.

The NICU at CHOC has created a general guideline for NICU babies to provide a successful “road map” from Day One feedings to advancement, or full volume feedings. Feedings are given every few hours. The timing and volume can change throughout the time your baby is in the NICU based on various factors you can discuss with your care team. Below is a general overview of the guidelines:

• First few days – a premature baby’s stomach and intestines may not be ready for breast milk or formula, so don’t be discouraged if your care team tells you that your baby will require an IV for hydration and calories. All solutions your baby receives will be specialized and made by the CHOC pharmacists.
• Progression – a solution called Total Parenteral Nutrition (TPN) will replace the IV feedings, providing protein, sugar water, vitamins and minerals to your baby, and another solution called Intralipid (IL) will offer fat through the IV.
• Breast milk or formula – once the baby is able to receive breast milk or formula, they may still need some time to take it in by mouth. When this is the case, there will be a very small tube passed through the nose or mouth into the baby’s stomach for feedings.