The Front Line

Oral feeding of premature infants

by Chantal Lau, Phd

Healthy term infants can feed by mouth immediately after birth, by breast or bottle. This is not so for the premature.

Safety is the primary concern with oral feeding. Babies need to feed without oxygen desaturation, apnea, bradycardia, or aspiration. Although fetal sucking, swallowing, and breathing have been observed, it is unknown when this process becomes coordinated in premature infants. Nor do we know when the premature infant is ready to feed by mouth, though oral feeding is usually introduced around 33-34 weeks’ postmenstrual age.

Premature infants may have difficulty transitioning from tube to oral feeding. Oral feeding should be a pleasant, nurturing, and positive experience. Given the repetitive noxious oral stimuli that the very smallest infants experience, they must have time to dissociate oral feeding from these aversive interventions. Some infants develop long-term feeding difficulties, even after hospital discharge. These infants should be promptly identified and referred to a feeding disorder clinic.

A premature infant is not a full-term infant, which may seem self-evident but in practice is not always considered. Prematures have an immature suck and are not efficient feeders. They rapidly fatigue and have poor endurance; thus, the feeding duration should be short. They often change states (sleepy, awake, crying) and cannot perform a task for a prolonged period.

Therefore, to improve oral feeding success, it is important to take advantage of certain factors. An optimal environment includes dim nursery lights, low noise levels, increased positive human contact, and making sure the infant is warm. Oral feeding is best when the infant is in a drowsy or calm alert state; oral feeding should not be given when the infant is sleeping or disorganized (highly aroused, fussy, crying). When disorganized, the infant will have difficulty coordinating sucking, swallowing, and breathing.

An infant is not ready to feed when he/she stares or avoids looking at you, has an expression of panic or worry, cannot wake up or yawns excessively, is tremulous, gasping or gagging, has abnormal vital signs, or has color changes. Similarly, oral feedings should stop if the baby manifests any of these same signs or shows evidence of fatigue (eg, drooling, no suck, apnea/bradycardia/oxygen desaturation).

With prematures, focus on developing good functional feeding skills rather than the quantity of milk ingested at one feeding. The Neonatal Feeding Team of the Baylor College of Medicine Section of Neonatology provides consultative and evaluative services throughout the nurseries of Baylor-affiliated hospitals.