Short-Term Enteral Feeding in NICU


Reviewed by David Knight
Clinical Guidelines Back Newborn Services Home Page
See also supporting documentation on the research evidence around formula use and breast feeding in NICU.
  • The optimal care is for all babies to receive breast milk only. This policy addresses those infants who do not need IV fluids and whose mothers have not established a breast milk supply.
  • In general, IV infusions should not be started if there are no medical indications for IV fluids (such as respiratory distress, hypoglycaemia etc.)
  • Babies who need feeding should be given what motherís breast milk is available and always receive motherís breast milk in preference to formula.  Be sure to check that no breast milk is available before considering infant formula.
  • If they require additional feeds, infants should then be started on term infant formula, after discussion with their mother/father. In such discussions, parents should be informed that there are few - if any - adverse effects of formula used short term in this way in a neonatal unit. Click here to review the evidence supporting this policy.
  • For a baby who is already on an IV infusion, it is reasonable to continue the infusion for a short time if motherís milk supply is being established and there is a reasonable expectation that she will be producing enough breast milk with in a day or so. This time period needs to be judged against the ease of IV access and the condition of the baby.  Babies should not have IVs re-inserted solely because no breast milk is available.
  • Smaller preterm infants will often have a medical indication for ongoing IV fluids and in them it is desirable to increase the oral fluids slowly.  The pace of increase of oral fluids can usually be matched to the increase in the availability of expressed breast milk.
  • Mothers should be advised and helped with expressing.  NICU staff should discuss expressing as soon as possible.  It is accepted that the role of initially helping with expressing lies with postnatal ward staff.  NICU staff should support mothersí expression of breast milk.
  • Nasogastric feeding rather than bottle or cup feeding is advantageous for ex-premature babies.  Term babies who do not have problems with hypoglycaemia can usually transition directly from IV fluids to breast feeds.  Alternatively, bottle or tube feeds may be used for larger infants.
  • NICU does not provide hydrolysed formula unless there is a clinical indication (other than a history of allergy). If there is a very strong family history of allergy, hydrolysed formula may be supplied on an individual basis.  Parents may supply their own formula (hydrolysed or non-cowís milk preparations) if they wish.