A premature infant is defined as a baby born before the 37th week of pregnancy. Feeding these newborns presents unique challenges because their organ systems are still developing. Providing adequate nutrition is crucial for a preemie’s growth, brain development, and overall health. Frequent feeding helps prevent serious complications, such as hypoglycemia, by maintaining a steady supply of energy and ensuring they receive the necessary calories for rapid catch-up growth.
Establishing Initial Feeding Frequency
Preemies require frequent, scheduled feeds, typically every two to three hours, around the clock. This strict scheduling is necessary because they possess minimal energy reserves and their small stomachs can only tolerate a small volume of milk at one time.
Going longer without feeding increases the risk of the baby’s blood sugar dropping to dangerously low levels. Caregivers must often gently wake a sleepy preemie for scheduled feeding, especially after birth or hospital discharge. The specific schedule is determined by the medical team based on the baby’s weight, health, and gestational age.
The traditional standard in neonatal units is a two-hourly feed schedule, though a three-hourly schedule may be safe for stable infants over 32 weeks postmenstrual age. Regardless of the interval, the goal is 8 to 12 feedings per day to ensure consistent nutritional intake. This frequent schedule helps the immature digestive system gradually adapt to enteral nutrition.
Understanding Feeding Methods and Volume
The feeding method is linked to frequency and determined by the preemie’s ability to coordinate sucking, swallowing, and breathing. Many preemies initially use gavage feeding, where milk is delivered directly to the stomach via a tube. This bypasses the need for coordinated oral feeding while ensuring the baby receives necessary nutrition for growth.
As the baby matures, feeding transitions to oral methods, such as breastfeeding or bottle feeding, though this process is often slow. Preemies may still need supplemental tube feeds during this transition to meet total daily volume requirements. The volume of milk is precisely calculated based on the baby’s weight and measured in milliliters per kilogram of body weight.
Initial feeds, called trophic feeds, are small amounts (roughly 10 to 20 ml/kg/day) that help stimulate the gut. This volume is gradually increased, aiming for a total intake of approximately 150 to 180 ml/kg/day by one to two weeks of life. Since the gastric emptying rate is proportional to the feed volume, smaller, more frequent feeds are easier to tolerate.
Recognizing Cues for Feeding and Satiety
As preemies mature, recognizing their subtle hunger and fullness signals becomes increasingly important, even with a strict schedule. Preemies often lack the energy for the loud cries of a full-term infant. Instead, earlier hunger cues include bringing hands to the mouth, rooting, or making sucking motions and noises.
For a preemie, crying indicates a high level of distress that makes feeding difficult. Recognizing early signals allows for a calm and positive feeding experience, which is beneficial since preemies tire easily. Subtle cues of satiety, or fullness, should also be watched carefully to prevent forced feeding.
Signs that a preemie is finished include turning their head away from the nipple, decreased sucking intensity, sealing their lips, or falling asleep quickly during the feed. Following these cues, once the baby is medically stable, can improve their ability to achieve full oral feedings and may shorten their hospital stay.
Adjusting the Schedule as the Preemie Grows
The shift away from strict, scheduled feeding times is a significant milestone that occurs as the preemie gains strength and weight. The primary indicators that a preemie is ready for a more flexible routine are consistent weight gain and the ability to demonstrate clear, reliable hunger and satiety cues.
The goal is to move toward demand feeding, where the baby initiates the feed based on hunger signals rather than the clock. This transition usually happens when the baby reaches a certain weight threshold or corrected age. Night feedings often remain necessary longer than for a full-term infant to maintain the rapid growth trajectory.
When a baby is consistently feeding well orally and growing steadily, the stretch between feeds may cautiously increase to four hours, with doctor approval. The doctor uses growth charts and developmental progress to guide changes in the feeding plan. This progressive adjustment supports the baby’s ability to self-regulate intake and moves toward typical infant feeding patterns.