Neonatal weight gain and nutrition

Definition

Premature babies need to receive good nutrition so they grow at a rate close to that of babies still inside the womb.

Alternative Names

Newborn nutrition; Nutritional needs - premature infants

Information

Babies born at less than 37 weeks gestation (premature) have different nutritional needs than babies born at full term (at 39 weeks or later).

Premature babies will often stay in the neonatal intensive care unit (NICU). They are watched closely to make sure they are getting the right balance of fluids and nutrition.

Incubators or special warmers help babies maintain their body temperature. This reduces the energy the babies have to use to stay warm. Moist air is also used to help them maintain body temperature and avoid fluid loss.

FEEDING ISSUES

Babies born before 34 to 37 weeks often have problems feeding from a bottle or a breast. This is because they are not yet mature enough to coordinate sucking, breathing, and swallowing.

Other illness can also interfere with a newborn's ability to feed by mouth. Some of these include:

Newborn babies who are very small or sick may need to get nutrition and fluids through a vein (IV).

As they get stronger, they can start to get milk or formula through a tube that goes into the stomach through the nose or mouth. This is called gavage feeding. The amount of milk or formula is increased very slowly, especially for very premature babies. This reduces the risk for an intestinal infection called necrotizing enterocolitis (NEC). Babies who are fed human milk are less likely to get NEC.

Babies who are less premature (born after 34 to 37 weeks gestation) often can be fed from a bottle or the mother's breast. Premature babies may have an easier time with breastfeeding than bottle feeding at first. This is because the flow from a bottle is harder for them to control and they can choke or stop breathing. However, they may also have problems maintaining proper suction at the breast to get enough milk to meet their needs. For this reason, even older premature babies may need gavage feedings in some cases.

NUTRITIONAL NEEDS

Preterm babies have a harder time maintaining the proper water balance in their bodies. These babies can become dehydrated or over-hydrated. This is especially true for very premature infants.

Human milk from the baby's own mother is the best for babies born early and at very low birth weight.

Premature babies have not been in the womb long enough to store up the nutrients they need and must usually take some supplements.

WEIGHT GAIN

Weight gain is monitored closely for all babies. Premature babies with slow growth appear to have more delayed development in research studies.

The desired weight gain depends on the baby's size and gestational age. Sicker babies may need to be given more calories in order to grow at the desired rate.

Premature babies do not leave the hospital until they are gaining weight steadily and in an open crib rather than an incubator. Some hospitals have a rule on how much the baby must weigh before going home, but this is becoming less common. In general, babies are at least 4 pounds (2 kilograms) before they are ready to come out of the incubator.

References

Ashworth A. Nutrition, food security, and health. In: Kliegman RM, St. Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM, eds. Nelson Textbook of Pediatrics. 21st ed. Philadelphia, PA: Elsevier; 2020:chap 57.

Cooke DW, DiVall SA, Radovick S. Normal and aberrant growth in children. In: Melmed S, Auchus RJ, Goldfine AB, Koenig RJ, Rosen CJ, eds. Williams Textbook of Endocrinology. 14th ed. Philadelphia, PA: Elsevier; 2020:chap 25.

Hand IL, Noble L. Premature infants and breastfeeding. In: Lawrence RA, Lawrence RM, eds. Breastfeeding: A Guide for the Medical Profession. 9th ed. Philadelphia, PA: Elsevier; 2022:chap 14.

Lissauer T, Carroll W. Neonatal medicine. In: Lissauer T, Carroll W, eds. Illustrated Textbook of Paediatrics. 6th ed. Philadelphia, PA: Elsevier; 2022:chap 11.

Poindexter BB, Martin CR. Nutrient requirements/nutritional support in premature neonate. In: Martin RJ, Fanaroff AA, Walsh MC, eds. Fanaroff and Martin's Neonatal-Perinatal Medicine. 11th ed. Philadelphia, PA: Elsevier; 2020:chap 41.



Review Date: 4/25/2023
Reviewed By: Charles I. Schwartz, MD, FAAP, Clinical Assistant Professor of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, General Pediatrician at PennCare for Kids, Phoenixville, PA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
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