One has an idea of a chubby term baby cuddling in your arms and latching at your breast immediately after birth. Sadly when your baby is born prematurely and gets whisked off to the Neonatal Intensive Care Unit (NICU), all your dreams come crashing down.
Take heart, all is not lost, and you will soon realize that the NICU is the next best place for your baby other than your womb. See the NICU as a substitute womb. The staff and doctors are there to replace your body’s umbilical cord, placenta and amniotic fluid. They will be keeping your premature baby alive and growing, not just surviving but also thriving.
The first question a mother asks us after her premature baby is admitted to the NICU is: ‘When do you think my baby will come home?’ and our answer is: ‘Ask yourself that question and then answer that question as if you were still pregnant.’ Your answer being when my baby is ready and safe to exist outside the womb – that is breathe and eat on its own without breathing pipes and feeding tubes. No NICU will keep a premature baby longer than needed so trust the doctors and relax in the journey and it will be so much easier for you.
Your baby’s digestive system matures and prepares for life outside the womb in the last trimester of pregnancy and this is the trimester all premature babies miss out on. The implications are an immature digestive system that will struggle to digest nutrients like a term baby would. The amniotic fluid your baby learns to swallow in the last month or two before birth has special properties that provide special nutrients to mature the digestive system. The placenta sends nutrients via the umbilical cord for your babies growth especially brain and nervous system development. There are very specific nutrients called amino acids that help with these systems.
When your baby is born prematurely even breastmilk is not ideal, it is by far the best and safest option, but it is neither placental food nor amniotic fluid. It is for this reason that when we feed your premature baby in the NICU, we need to provide some additional assistance to the digestive system. This may be in the form of Total Parental Nutrition (TPN) that gets given to your premature baby via his veins. TPN mimics, as far as possible, the placenta food.
We have not got any food source that can mimic amniotic fluid but moms expressed breastmilk comes in at a close second. We will encourage and assist you in every way possible to express your breastmilk for your baby.
As a neonatal dietitian, I would also recommend including some wonderful foods intentionally in your diet to increase some specific nutrients that your baby would have received from your body in the last trimester. You can find these notes on our Resources Page. In that way, your premature baby gets some amazing opportunity to grow and develop their digestive system as if they were still growing inside of you.
Lastly, your baby’s ability to feed themselves from the breast or via a bottle would require the ‘suck-swallow-breathe’ mechanism to be in place. This rarely develops before 37 weeks of age. They learn to suck in the womb (you often see them sucking their thumbs) and they learn to swallow the amniotic fluid. They will only breathe spontaneously once born and only then will they learn to co-ordinate all three together while feeding. Developmentally they are capable of this from 37 or 38 weeks gestation.
In the beginning, this takes a lot of conscious co-ordination on your baby’s part. The harder they need to work at feeding, the more tired they get. In the NICU, we need to manage the energy your premature baby expends whilst learning to feed as well as the energy they need to grow. We can’t rush this process otherwise we will compromise their growth and we could also create a feeding aversion. A feeding aversion will cause a baby to not want to drink and this can be very challenging and needs to be avoided at all costs. We can avoid both these complications by not rushing the process and watching the premature baby’s cues. The staff in the NICU are well trained to do this so don’t get discouraged if this process takes a while as your baby will eventually become a skilled feeder.