Tube Feeding

Evidence  

https://www.sciencedirect.com/science/article/abs/pii/S0378378212700117?via%3Dihub 

L. Maggio, S. Costa, C. Zecca, L. Giordano 

Whenever possible, oral feeding is the preferred method in neonatal feeding. However, many premature infants are unable to suck and swallow effectively; in these cases, alternative methods of nutrient delivery must be used.   

Education 

Feeding babies in the Neonatal Unit is quite different from feeding healthy babies. When babies are sick or premature, they are often not well enough to breastfeed or take a bottle. Premature babies may not be able to suck effectively. Or their GI (gastrointestinal) tracts may not be mature enough to digest feedings. Babies who have unstable health are often unable to take regular feedings. Babies with umbilical catheters and those who need help breathing, such as with a mechanical ventilator, may not be able to be fed. This is because of the risk of problems such as aspiration (breathing food into the lungs). 

Many babies in the Neonatal unit receive vital fluids and electrolytes through an intravenous tube in a vein. Some babies may need a special fluid called parenteral nutrition (PN). This has nutrients they need until they can take milk feedings. 

https://www.miraclebabies.org.au/content/other-forms-of-feeding/gjseqw 

In babies born premature, the coordination of sucking, swallowing, and breathing needed for effective feeding is usually not fully established until about 32 to 34 weeks’ gestation, although this can vary depending on baby’s medical needs. Babies born at term and are sick may also take longer to co-ordinate feeding. Tube feeding will help your baby receive enough nutrition to grow and develop. 

There are a few different types of Tube Feeding, these are:  

Orogastric tube (also called OG tube) -A feeding tube that goes in your baby’s mouth, down the oesophagus and into the stomach. The oesophagus is the tube in your baby’s body that carries food from the throat to the stomach. Your baby can get breast milk, formula, and medicine through an OG tube. When a baby is fed breast milk or formula though an OG tube, it’s called gavage feeding. 

Nasogastric tube (also called NG tube) - A feeding tube that goes through your baby’s nose, down the oesophagus and into the stomach. The oesophagus is the tube in your baby’s body that carries food from the throat to the stomach. Your baby can get breast milk, formula and medicine through the tube. When your baby is fed breast milk or formula though an NG tube, it’s called gavage feeding. 

Gastrostomy tube (also called g-tube or gastric feeding tube)- A tube that goes into your baby’s stomach for feeding. Liquids go through the tube to feed your baby. The tube is used for babies who can’t take food by mouth and need long-term help with feeding. 

Feeding tubes are usually left in place until the baby is able to feed by mouth. At first, tiny amounts of breastmilk or formula are given through the feeding tube. Because of their small stomach size, very tiny babies may be fed using a pump that slowly gives the milk in small amounts. As the babies grow, they can take larger amounts at each feeding. 

Feeding practice from breast or bottle can begin as soon as babies are stable and are able to suck well. Your baby will likely begin to practice feeding by mouth while still being tube fed. Even if a baby shows interest in a feeding, it can be tiring. You will need to pay attention to your baby's cues that show they are tired. If you are using a bottle, it is important to help your baby pace the feeding.  

Learning to feed by mouth is a gradual developmental process. It can take several weeks for premature babies. So, it’s normal to take only occasional small amounts by bottle or at the breast. To find out how much milk a baby is getting at the breast, he or she can be weighed before and after the feed using a special scale. As your baby increases the amount they can safely and comfortably take by nipple, the amount given in the tube feedings can be decreased. 

Going home with tube feeding 

Most premature and sick babies outgrow feeding problems before they leave the hospital, and parents don't have to worry that they will need to use feeding tubes at home. Other premature or sick babies have complications that cause oral aversions or long-term breathing, digestive or neurological problems. 

If your baby is ready for discharge but still having some trouble feeding, at-home NG tube feeding may be an option.  

Prior to discharge you will need to attend basic newborn resuscitation training, education training on managing nasogastric tube at home and ensure a feeding plan is developed with your lactation consultant and neonatologists.  

Support is available once you are at home and your healthcare team will provide you all the information needed. 

Empowerment  

Your baby's healthcare team on the neonatal unit will encourage you to be as involved as possible in the care of your baby. If you feel comfortable doing so, they can show you and your partner how to give tube feeds. Your healthcare team will show you how to: 

• Check the tube is in the correct position before feeding 

• Prepare the milk and fill the syringe that is connected to the feeding tube 

• Position your baby correctly for tube feeds 

• Give the milk slowly to support comfortable digestion 

• Know what to look for during a feed 

This can feel quite scary at first, but with practice you should gain confidence. You will have the time to give the milk very slowly which helps your baby to digest more comfortably. 

If your baby is well enough to come out of the incubator, you and your partner can also practice skin-to-skin contact with your baby while they are tube feeding. Skin-to-skin contact has lots of benefits for you and your baby and helps parents to feel closer to their baby and more confident in caring for them. 

Useful Links  

Australian Breastfeeding Association  

https://www.breastfeeding.asn.au/resources/breastfeeding-your-premature-baby 

The Royal Women’s Hospital, Victoria  

https://www.thewomens.org.au/health-information/breastfeeding/breastfeeding-sick-and-premature-babies/an-early-start 

Australian Government – Department of Health and Aged Care 

https://www.health.gov.au/topics/pregnancy-birth-and-baby/breastfeeding-infant-nutrition