A feeding tube in the Neonatal Intensive Care Unit (NICU) delivers breast milk, formula, or specialized formulas directly to infants who cannot feed orally. This temporary or long-term method ensures proper growth and development by providing adequate nutrition when oral feeding is not yet possible or safe.
Reasons for Use
Infants in the NICU may require a feeding tube due to medical reasons that prevent oral feeding. Prematurity is common, as babies born before 32 to 34 weeks gestation often have underdeveloped suck, swallow, and breathe reflexes, making oral feeding inefficient or unsafe. They also have low energy reserves, requiring consistent, small nutritional feeds to prevent depletion.
Congenital conditions can also necessitate tube feeding. Infants with heart defects might expend too much energy during oral feeding, while conditions like cleft palate can make it physically difficult to create suction or swallow effectively. Severe illnesses or infections, such as respiratory distress or neurological conditions, can also impair a baby’s ability to feed orally.
Types and How They Work
In the NICU, the most common types of feeding tubes are nasogastric (NG) and orogastric (OG) tubes. An NG tube is a thin, soft, flexible tube inserted through the baby’s nose, down the esophagus, and into the stomach. Similarly, an OG tube follows the same path but is inserted through the baby’s mouth. Both types are generally used for short-term feeding support.
These tubes deliver nutrition directly to the stomach, bypassing the need for oral sucking and swallowing. Feeds, which can be breast milk, formula, or specialized formulas, are administered via a syringe or an infusion pump. With a syringe, milk is allowed to drip slowly by gravity into the stomach, or it can be gently pushed through the tube. For continuous feeding, a pump delivers smaller amounts over a longer period, often 18 to 24 hours.
The Feeding Process and Parental Role
The feeding process in the NICU involves careful monitoring and active parental participation. Feeding schedules are established by the medical team, with feeds occurring every few hours, and the baby’s feeding progress, including weight gain and tolerance, is closely tracked. Nurses will teach parents how to prepare milk, fill syringes, and position their baby for tube feeds.
Parents can be involved in their baby’s feeding journey, even with a tube. Providing breast milk for tube feeds is beneficial, and parents can participate in administering the feeds themselves after receiving instruction from the nursing staff. Offering non-nutritive sucking, such as a pacifier, during tube feeds can help babies associate sucking with a full tummy and promote comfortable digestion. Skin-to-skin contact, also known as kangaroo care, during feeds or at other times supports bonding and encourages pre-feeding skills like rooting and sucking. Gentle oral stimulation, under guidance from the medical team, can help prepare the baby for eventual oral feeding.
Transitioning Off and Beyond
Transitioning an infant off a feeding tube is gradual and carefully managed by the NICU team. Readiness for oral feeding is assessed based on the baby’s stable medical condition and observable improvements in their suck and swallow reflexes. This transition begins around 32 to 34 weeks gestational age, but the timeline can vary for each infant.
As the baby demonstrates increasing ability to take milk by mouth, either from the breast or bottle, the volume of tube feeds is gradually decreased. This allows the baby to build stamina and coordination for oral feeding without immediate pressure to consume all nutrition orally. While some infants transition quickly, others may experience challenges such as fatigue or initial reluctance to feed orally. The NICU team provides support and guidance throughout this process, including feeding specialists. After discharge, continued follow-up care for feeding development may be recommended to address any needs and ensure continued progress.