The Prenatal Consult (Part VI)

This is part VI of a series of posts which also currently includes part I,  part II , part III, part IV, and part V.
One of the biggest challenges for all premies is getting adequate nutrition. So this is usually the next area of discussion that I address with parents during the prenatal consult. The last trimester of pregnancy is one in which a lot goes on nutritionally for babies and missing out on it puts them at quite a disadvantage.
I start by pointing out that the premature intestine, like other organs, does not function the same way as a full term intestine. It doesn't move things along very well, it doesn't absorb nutrients as well, and it is at risk to develop some complications (like NEC) that can be problematic. So in the beginning we start by infusing "IV Nutrition" (otherwise known as hyperalimentation). I always point out to mothers that this is a similar way of delivering fat, protein, carbohydrate, vitamins and minerals to what occurs in utero, however, it is inferior. We then begin feeding a small amount of breast milk by NG tube and then gradually increase this over about a week to ten days. I explain that we introduce enteral nutrition this way, and strongly encourage the use of breast milk in an effort to reduce the incidence of NEC. Once the baby is receiving all of the feedings by this route, we use a human milk fortifier to increase the calories as well as some of the vitamins and minerals that are essential for bone mineralization.
I also explain that babies don't develop the reflexes that are necessary to suck, swallow, and breath in a coordinated fashion until they reach about 34 weeks gestation. For this reason, until they are ready, they are fed by a nasogastric tube. Once the baby is able to feed once or twice a day, we gradually increase the number of feeds that the baby gets by bottle as opposed to NG tube. In order to be discharged, the baby must be capable of taking all of the feedings by mouth.
The next topic that I cover is the risk of infection and the likelihood of blood transfusion. So tune in next time.