We encourage mothers to breastfeed their infants, but many babies are unable to nurse right away. There are several different ways we can provide nutrition to your infant in the NICU.
When a baby is sick, or cannot tolerate feeding, then nutrition is provided through Intravenous (IV) fluids. These fluids can be given through several different lines:
Peripheral IV catheter: This is a small tube inserted into a vein that allows fluids with dextrose (sugar), proteins, minerals and even fats to be given to the baby. Many medications are also given through the IVs. An IV pump is used to infuse the correct amounts of fluid to the baby. IVs can be placed in veins of the hands, arms, feet, legs and occasionially in the scalp. Peripheral veins are very fragile and therefore these IVs often need to be replaced every few days.
Umbilical catheter: This is a catheter inserted through the end of the baby's umbilical cord (belly button) and threaded through the umbilical vessel into a main artery or vein. It is not painful and provides a way for us to provide IV fluids and draw blood. If the catheter is placed in an artery we can also use it to monitor blood pressure.
Central lines: This is a thin catheter that may be placed in a vein in the arm, leg, or even neck or scalp and inserted until the tip is in a large vessel near the heart. This can stay in place much longer than the regular IV and can be used for higher concentrations of nutrients and medications. Occasionially it is placed by making a tiny incision over the baby's vein and then the tube is threaded through the vein until it reaches the appropriate position.
Your baby's gestational age, level of development and clinical condition determine when he/she will be able to tolerate feeding. Feeding can mean tube feeding or breast/bottle feeding. Often the baby is started on very small amounts, which are increased slowly as the baby demonstrates they are able to tolerate them.
Gavage feedings: Newborns are often too young or too sick to be able to suck from a bottle. Until that time they may need to be gavage fed. This is when a tube is placed from the mouth or nose and advanced into the stomach. Feedings are given through this tube often over a ½ - 1 hour period.
Nippling: Premature babies can usually start to learn to "nipple" feed (take milk from a bottle) around 34 weeks gestation. When a baby is ready to "nipple" feed we begin slowly with 1-2 feedings/day. When the infant can suck well enough to tolerate those feedings without tiring, we advance to more feedings/day. Our Occupational and Physical Therapist are experts at helping the babies learn to effectively coordinate a "suck/swallow". They will work with the baby every day to evaluate the feedings and recommend the plan to advance "nippling".
Breastfeeding: Often when a baby is in the NICU he/she cannot yet breastfeed. We would love to have breastmilk available to give to the babies by gavage feedings or bottle feeding until they can actually get on the breast. We recommend Mothers start pumping milk within the first 24 hours after delivery, if at all possible. Pump for 15-20 minutes every 3 hours with a goal of 8 pumpings in a 24 hour period. The NICU will provide you with bottles to store your milk. Please use a preprinted baby label to label the bottles and add the date and time of pumping. Store the milk in the freezer. To transport milk to NICU, place on ice or with cold packs to maintain temperature and prevent thawing.
The use of a hospital grade pump in recommended in order to maintain your milk supply while baby is in the NICU. Mothers in the WIC program should contact their WIC office to make arrangements to borrow an electric pump. Maternity at Providence Saint Joseph Medical Center rents electric hospital grade pumps by the month or by the week. They also rent and sell Medela products including pumps and breastfeeding supplies. You can reach Maternity at 818-847-4143. A private pumping room is available for NICU mothers for use while visiting the NICU.
Lactation consultants are available. If you would like information or help with breastfeeding, let your baby's nurse know that you would like to speak with a consultant.