How will my baby be fed in the neonatal unit?

The sucking, swallowing, and breathing coordination necessary for your newborn to feed develops between weeks 34 and 36 of gestation. Ideally, you would breastfeed a premature baby with a breast or bottle. If this isn’t possible, your baby will be fed via a tube passing through their nose or mouth into their stomach. This is known as enteral feeding, a term you will hear a lot in the neonatal unit. If your baby cannot yet digest milk, they will be fed a fluid called Total Parental Nutrition through a vein. TPN contains the perfect combination of carbohydrates, fat, salts, and protein. Doctors formulate it based on your baby's age and blood tests and administer it through a fine tube called a long line through a large vein. This process comes with significant risks, including blockage, leakage, and infection, and your baby is fed this way only as long as absolutely necessary. Afterwards, your doctors will slowly try milk feeds.

What is nasogastric or orogastric feeding?

The best milk your premature baby can receive is your own breast milk, which is a dynamic product naturally produced for their specific needs. It supports their gut health and contains antibodies that help them fight infection, as well as the perfect combination of protein, fat, and carbohydrate for them to flourish. Until they can feed themselves, your expressed breastmilk will be delivered through a slim tube that passes through their mouth or nose and is gently pushed until it reaches their stomachs. This shouldn’t hurt or bother your baby, and litmus paper is used to test if it’s in the right place (the stomach contains acid) before your milk is delivered through a syringe. The nurses will start by introducing a small amount every few hours, then more as your baby can tolerate it. Tube feeding can stop when your baby’s sucking, swallowing, and breathing coordination develops, though bottle or breastfeeding may still take more patience than they would with a term baby. The nurses may suggest that you offer a dummy after they finish a tube feed, so they associate sucking with food, and that you allow them to lick and seek your breast during kangaroo care. The staff will show you the best positions to encourage breastfeeding and also look for signs a baby is ready to start, such as turning their head and opening their mouth wide. Even when they start, they may have to combine tube feeding and breastfeeding because they are unable to suck for very long.

Try to be patient. The breastfeeding relationship will get stronger with practice, and soon your baby will feed every few hours. If you’re able to express, they can also be bottle-fed, though the hospital can also provide donor milk or a special baby milk formula if you have trouble. Donor milk is considered superior to formula because human milk is better at preventing NEC and other problems with premature babies’s gut health. However, because donor milk is pasteurised, its immunological benefits still aren’t as good as your own milk. You deserve all the support possible where breastfeeding is concerned. Mothers in the neonatal unit experience separation from their baby and an enormous amount of stress. You may be recovering from a C-section or health problems related to or exacerbated by the birth. Whatever affects your ability to breastfeed, someone on the unit should be available to help you. That said, if you do need to feed your baby formula, this will provide your baby with everything they need to grow strong and healthy. There is no need to be hard on yourself. What you are going through is hard enough.

What’s normal in my baby’s nappies?

A dehydrated baby won’t produce enough wet nappies per day. When your baby first arrives in the unit, their healthcare team will be monitoring their nappies for volume—every millilitre matters—and colour, as brown wee can indicate your baby has liver problems. They may not pass their first poo for a while, as they’ve had nothing by mouth. If they take an especially long time, your doctor may give them a glycerine suppository to get things moving. Their first poo will be black meconium, and after that, the colour should change as a regular newborn does, whether the baby is fed via their stomach or a vein. A doctor will investigate if their poo is bloody, or putty-coloured, which suggests gut, and liver problems, respectively.

How will my baby be monitored in the neonatal unit?

Your baby’s development and wellbeing will be monitored in a variety of ways, some of which may be specific to any health concerns. The following are some standard checks you can expect:.

Like any newborn, a premature baby will have a heel-prick test to test for metabolic and other potentially life-threatening disorders, among other blood tests. These tests can be challenging if a baby is very premature or ill, as they don’t reproduce blood quickly enough to replace what’s drawn. The amount of blood taken from such babies is logged, even if it is as little as 1 ml, and will be replaced with a top-up transfusion if necessary.

Blood pressure checks are made using a transducer, which is an electronic device attached to a line that goes into an artery and monitors it continuously. A tiny version of the inflatable cuff that measures your blood pressure can also be used on your baby.

Bone chemistry checks measure calcium, phosphate, and alkaline phosphatase levels, which are all important to bone growth.

Cranial ultrasounds can give a doctor lots of information about your baby’s brain, including whether there has been a haemorrhage or if there is too much fluid. The scans won’t hurt your baby.

Eye checks are especially important, as premature babies are vulnerable to Retinopathy of Prematurity (ROP), which causes blood vessels to develop where they shouldn’t, sometimes leading to retinal detachment or blindness. Babies showing signs of this will have the abnormal cells lasered. However, some premature babies are too unwell and fragile to receive laser treatment, which also carries a risk of leaving scarring on the retina and permanently damaging vision. The new drug is now available across England as an alternative to laser treatment for some forms of ROP, following the publication of new national NHS guidance. Ranibizumab is administered into the eye using a precise injection system that does not cause any scarring, which is particularly important in babies with ROP in the central, most sensitive part of their vision. ROP isn’t common, but your baby’s risk increases if they are very premature and been given lots of oxygen, so they’ll be monitored carefully.

A full blood count checks your baby’s haemoglobin, which carries oxygen around the body; white blood cells, which are produced to fight infection; and platelets, which help their blood to clot.

Hearing checks will happen before your baby leaves the unit and involve quiet clicking sounds being played into your baby’s ear while a doctor monitors their response. If they’ve had meningitis or severe jaundice, they’ll be given further assessments.

Hernia checks are important because your baby is more vulnerable to them than term babies. A hernia is a lump in a baby boy’s groin whic may go into the scrotum. It is due to part of the baby’s gut extending through a weakening in the abdominal wall and will usually come and go but sometimes get stuck. A doctor can often diagnose a hernia based on what they see, though if an examination is necessary, it may be painful, and crying will make this worse, so your baby will be given pain relief. The doctor will want to reduce the hernia, gently push it back where it should be.

What about parental consent?

Your doctors and nurses will explain the above checks and tests to you and usually assume consent to everyday procedures. You will usually have to fill out a consent form for anything surgical after the risks are explained to you.

How will my premature baby be fed and monitored in the neonatal unit?

Breastfeeding is best for premature babies but what else can you expect if your newborn needs extra care after birth?