Feeding the ill or preterm infant

Illness and immaturity often interfere with a neonate's ability to receive full enteral feedings during the first week of life. The goals of feeding in the NICU are to nourish the preterm infant for appropriate growth and development and to facilitate the earliest possible discharge from the NICU. Early, small-volume feedings, or trophic feedings, have been studied as a method for achieving these goals. The high-risk infant given such trophic feedings not only receives minimum enteral nutrition, but also attains earlier full nutritional feedings and, consequently, is discharged home earlier. Oro- or nasal-gastric gavage feedings are usually indicated for this group of infants because of their physiologic immaturity and the frequent presence of respiratory illness. Recent studies support the use of intermittent bolus feedings, which have long been used for the premature infant. Several authors have noted advantages to continuous infusions as well. Because the infant is unable to pace or refuse gavage feedings, the caretaker must determine the appropriate volume of each feeding. The optimal volume for initiation and advancement of trophic and nutritional feedings is still under investigation, but reports have demonstrated safe volumes for even the extremely premature infant.