Learn about the unique nutritional needs of preemies and how the formula choices you make for them can give them the healthiest start possible. Although you should always be guided by a neonatologist or pediatrician, it’s important to understand why certain preemie formulas and feeding routines may be better than others—and when it may be time for a change.
Preemie Formulas in the NICU
For many babies born prematurely, feeding can be a challenge. They often lack the overall strength and coordination to perform the sucking motion necessary to bottle-feed or breastfeed. Preemies may also have an immature gastrointestinal (GI) tract, so their bodies may not properly break down milk proteins to absorb vital nutrients. Some preemies also have GERD or acid reflux, causing them to spit up large amounts of formula or breast milk. To get on a healthy growth track, many preemies in the NICU start out receiving formula or pumped breast milk through a thin feeding tube. These tubes are inserted either directly into their stomach, through their nose (nasogastric tube), or through their mouth to their stomach (orogastric tube). Others have nutrients delivered directly into their bloodstream through an intravenous (IV) line. According to the American Academy of Pediatrics (AAP), babies should be given breast milk, which has unique immune-boosting benefits, whenever possible. Often, fortifiers derived from human milk are combined with pumped breast milk to boost calories and nutrients. Recent research suggests human milk fortifiers might be safer and healthier for babies than cow’s milk fortifiers. If you can’t or choose not to breastfeed or pump breast milk, your NICU doctor will likely recommend a special formula to meet your preemie’s nutritional needs. Preemie formulas tend to have more calories, protein, vitamins, and minerals than regular infant formula and are designed to help underweight babies grow faster. Common ones for babies to receive in the NICU include Similac Special Care and Enfamil Premature.
Post-Discharge Preemie Formulas
NICU doctors usually determine when a preemie or low birth weight baby is ready to leave the hospital based on when they have met certain developmental milestones. Once your baby has been discharged, you have a few different feeding options for your baby. If your baby is unable to get enough nutrients from breast milk alone, you can supplement breast milk feedings with formula for increased protein, calcium, and fat. Or, you can feed your baby with a doctor-approved formula for preemies exclusively. It’s important to follow the doctor’s recommendations for low birth weight and premature babies with unique nutritional needs. Typically, preemies transition to a preemie discharge formula before going home. These include products like Similac Neosure or Enfamil EnfaCare. They have higher calorie counts and more protein, vitamins, and minerals than regular infant formulas, so that catch-up growth started in the hospital can continue at home. Premature babies with certain digestive issues or food allergies may benefit from special infant formulas. Here are some of the most common types of formula for preemies with special dietary needs.
Amino Acid-Based Formula
Babies with severe stomach problems may be sensitive to most formulas. For these infants, a formula that contains free amino acids (the building blocks of proteins) may promote growth. These products include EleCare, Enfamil PurAmino, and Neocate.
Lactose-Free Formula
On occasion, a baby may not have enough lactase, the enzyme used to digest the milk sugar lactose. Because these babies don’t digest milk sugars well, they may experience uncomfortable gastrointestinal (GI) symptoms like stomach pain, bloating, gas, and diarrhea, which may cause them to be especially fussy or cry excessively. In these cases, it’s best to speak with your baby’s pediatrician to determine which formula is best for your baby.
Hypoallergenic Formula
Some babies are allergic to both cow’s milk proteins and soy proteins. Hypoallergenic formulas contain pre-digested proteins, so babies who are allergic to milk proteins are usually able to tolerate hypoallergenic blends. Babies with GI conditions or food allergies may benefit from a hypoallergenic formula like Similac Alimentum or Enfamil Nutramigen.
How to Choose a Preemie Formula
Preemie formula is designed to provide all the protein, vitamins, and minerals a premature baby needs to catch up on growth and development. The best formula feeding plan for your preemie will depend on their overall development, unique dietary and nutritional needs, and any food allergies they may have. Discuss these factors with your baby’s neonatologist or pediatrician to determine the best preemie formula for your baby. The same is true if you want to change their formula. As your baby gains weight and gets stronger, their nutritional needs may change. Or, you may just want to see if your baby prefers a different product. Don’t switch baby formula until you’ve spoken with your doctor. While different infant formula products serve different needs, all formulas sold commercially in the United States must meet the same nutrition and safety standards. Whichever formula you feed your premature baby, ensure it is safe by only buying products from reputable brands and retailers, checking the expiration date on the package, and looking for odd colors or odors that suggest the formula is expired or has been tampered with.
How to Use Formulas for Premature Babies
Because premature babies have strict dietary needs and are especially vulnerable to infection, it’s important to follow the right steps to prepare your baby’s formula. Remember that it is so important for preemie babies to get all the calories and nutrients they can from their formula. For that reason, it should never be diluted.
When to Stop Using Preemie Formula
If your doctor recommends a premature baby formula, it’s important to keep using it for as long as they recommend. Depending on your baby’s unique needs, that may be until your original due date or several months later. Often, doctors are looking for the baby to achieve catch-up growth (rapid growth marked by notable weight gain, height increase, and increased head circumference). From preemie formula, your doctor may transition your baby to regular infant formula (if under 12 months) or cow’s milk (if over 12 months). Specific feeding plans will vary, as every baby has their own health needs and concerns.
A Word From Verywell
It can be scary and overwhelming to take a premature baby home from the NICU and suddenly be responsible for all of their care. But with support from your baby’s neonatologist and care team, you can find a feeding routine that works for your baby and provides all the nourishment they need to grow healthy and strong. If you choose to or need to feed your preemie formula, take care to consult a doctor on what kind and what amount is best for your baby. Regular check-ups and discussing each feeding transition will ensure your preemie continues healthy development through infancy and beyond.
