Challenges of Feeding Low Birth Weight Infants: A Pediatric Perspective

Milk consumption issues?

Hello doctor, my child was born at 39 weeks as a late preterm low birth weight infant, weighing 1980 grams at birth.
Now that he is one month old, he weighs 2655 grams.
He is still in the hospital and is being fed through a nasogastric tube because his oxygen saturation drops slightly when he drinks milk.
The doctors have kept the nasogastric tube in place for feeding.
He is fed every three hours with 50 cc of milk, but when offered to drink from a bottle, he only takes 10-20 cc before refusing more.
The doctors then administer the remaining amount needed to reach 50 cc through the tube.
Previously, the doctors mentioned that he would spit up a little after feeding, so they prescribed antiemetics for him.
His oxygen saturation drops slightly during feeding, and they have also prescribed bronchodilators.
After birth, he underwent 21 routine newborn screenings at National Taiwan University Hospital, all of which were normal.
The doctors have contacted a speech therapist to assist with oral rehabilitation, but after several days, he still only drinks 10-20 cc.
The doctors indicated that we should wait until he is a bit older to reassess the situation.
Could these issues be due to him being too small, or is it that his sucking ability is not yet mature? After all, he has already reached 2655 grams.

Lin Xiansheng, 30~39 year old female. Ask Date: 2022/04/24

Dr. Xie Wanghu reply Pediatrics

The baby's sucking ability is not yet fully developed and should be approached gradually.
It is recommended to feed on a schedule, providing 50cc every 3 hours.
If the baby consumes 20cc and it has been more than half an hour, do not feed again until the next meal.
Since the baby's birth condition and growth status are unclear, if the mother has any concerns, it is advisable to consult the primary physician or a rehabilitation therapist.
Thank you.

Reply Date: 2022/04/24

More Info

Feeding low birth weight infants, particularly those who are born at term but are still classified as low birth weight, presents unique challenges that require careful management and understanding. In your case, your child was born at 39 weeks with a birth weight of 1980 grams and is now at 2655 grams, which indicates a positive growth trajectory. However, the feeding difficulties you are experiencing are not uncommon in this population.

Firstly, it is essential to recognize that low birth weight infants often have immature feeding skills. This immaturity can manifest as difficulty with sucking, swallowing, and breathing coordination, which can lead to challenges during feeding. In your situation, the use of a nasogastric tube for feeding is a common practice when infants are unable to consume adequate amounts of milk orally, especially when there are concerns about oxygen saturation levels during feeding. The fact that your baby’s oxygen levels drop slightly during feeding is a sign that their respiratory system is still developing and may not yet be fully coordinated with their feeding efforts.

The current feeding regimen of 50cc every three hours is appropriate, but the fact that your baby is only able to consume 10-20cc by mouth indicates that their sucking reflex may still be developing. It is not unusual for infants of this size and age to have a limited oral intake initially. The recommendation from your healthcare team to continue with oral feeding attempts while also providing supplemental feeding via the nasogastric tube is a balanced approach to ensure your baby receives adequate nutrition while also encouraging the development of oral feeding skills.

Regarding the use of antiemetics and bronchodilators, these medications are often prescribed to manage symptoms that can arise during feeding, such as reflux or respiratory distress. It is crucial to follow your pediatrician's guidance on these medications, as they are tailored to your baby's specific needs.

As your baby grows and develops, you can expect improvements in their feeding abilities. Typically, as infants reach around 34-36 weeks postmenstrual age, they begin to show more significant progress in oral feeding skills. Continued support from occupational or speech therapists specializing in feeding can be beneficial in helping your baby develop the necessary skills for successful oral feeding.

In summary, the challenges you are facing with your low birth weight infant are likely due to a combination of their developmental stage and feeding skills. It is essential to remain patient and supportive during this time. Regular follow-ups with your pediatrician and feeding specialists will help monitor your baby's growth and feeding progress. As your baby matures, you should see improvements in their ability to feed orally, which will ultimately lead to a more typical feeding pattern.

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