How Much Should Preemie Babies Eat When Feeding?

Little Boy Drinking Milk
Premature babies have specific nutritional requirements. (Image: benedamiroslav/iStock/Getty Images)

Preemies, or infants born prematurely at less than 37 weeks gestation, have a high risk for feeding and growth problems, gastroesophageal reflux and other complications. Parents are faced with many challenges as they adjust to having a preemie, and feeding is one thing that both the parents and the baby must learn to do before coming home from the Neonatal Intensive Care Unit, or NICU. Because preemies have unique needs, it is important to get specific recommendations from your pediatrician or neonatologist.

In the Neonatal Intensive Care Unit

Preemie babies often spend time in the NICU where they receive careful monitoring and specialized feeding strategies if oral feeding is not possible. Homeostasis is the body's process of regulating its basic needs, including temperature, heartrate, respiration and food intake/output. As preemies are working hard to gain or maintain homeostasis, it is especially important that their diets be monitored for nutrients, fluids and electrolytes. Kangaroo care is a method of holding your baby skin-to-skin, which promotes bonding and has been shown to positively affect premature infants' health and readiness for feeding.

Breastfeeding Your Preemie

It is possible and beneficial to breastfeed your preemie, even if you have to initially pump and build your milk supply while your baby matures her suck pattern and physical readiness. When breastfeeding in the NICU, specially-trained nurses and lactation consultants can help with positioning your baby and using a supplemental nursing system if necessary. The March of Dimes recommends pumping or nursing every two to 2.5 hours, or eight to 12 times per day to establish your milk supply.

Bottle Feeding Your Preemie

Preemie babies may need to develop their suck-swallow-breathe sequence before they are ready to bottle feed. Once they are ready, most preemies will need 100 to 120 calories per kg of weight per day, although some will require up to 160 to 180 calories per kg. Breast milk is recommended over formula if possible, as it helps reduce risk of infections and SIDS. Donor breast milk can also be used; in fact, the Cochrane Database Review System reports infants that were given donor breast milk instead of formula had a reduced risk for Necrotizing Enterocolitis, the most common and serious GI disorder among preemies in the NICU.

How to Know if Your Baby is Getting Enough

In general, you will know if your preemie is well-fed if he has six to eight wet diapers per day and one to six stools per day. Weight gain is difficult to predict, though you should expect your preemie to gain approximately 1/4 oz. per day for every pound he weighs. Both breastfed and formula-fed preemies often need additional nutritional supplements.

When to Seek Professional Help

If your baby has difficulty sucking or latching at the breast or bottle, it is important to seek the help of a lactation specialist or feeding therapist. It is also important to monitor what comes out of your preemie. Any blood in the stools could signal a problem, as could frequent vomiting.

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