Feeding strategies after NICU discharge

Planning is key when it comes to strategies for feeding a baby upon discharge from the neonatal intensive care unit (NICU), said Steven Abrams, MD, professor of pediatrics, Baylor College of Medicine, Houston, Texas. During the Saturday, October 26, session titled “Evidence-informed premature feeding guidelines at the time of hospital discharge and in the first year of life,” Abrams discussed such issues as which babies are most at risk and how long supplemental nutrition is needed.

He said that low-birth-weight infants often exhibit suboptimal nutrition at discharge and that “one of the most important things” and something that represents “a change in practice” is that we now encourage staff to not wait until the day before a preemie is going home to focus on specialized nutrition needs. Careful planning should begin at least 3 days prior to discharge. “The family needs to find the formula and make sure they can get it.” He explained that experts recommend transitional (22 kcal/oz) formulas for premature infants with birth weight of less than 1,800 g and noted that specialized feeding strategies are generally continued until 4 to 6 months corrected age or until all growth parameters are above the 25th percentile.

“Families need written instructions on how to feed the babies,” Abrams continued. They almost always have questions such as, “Should I let the baby skip a feeding at night? Babies are fed in the hospital usually every 3 to 4 hours, so families always ask, ‘Well, if my baby is sound asleep in 3 to 4 hours, should I wake him up?’”

The answer, Abrams explained, depends on the baby’s size and how it is growing. “Often in the first week home, parents will need to wake the baby every 3 to 4 hours, but this can rapidly be spaced out if the baby is growing well.”

Growth is a critical area that requires measurement by the pediatrician in the first few weeks after discharge of a small baby. He said that “balance” is key. “We try to focus between getting enough growth and making sure babies don’t overgrow, because it’s possible that after periods of time on these high-calorie formulas that babies will grow too fast.”