Bridging the gap: Feeding the hospitalized infant

NICUs constantly work on optimising procedures to bridge the gap in the breastfeeding development of ill or premature infants. Utilising research-based and process-optimised innovations, as well as research reviews and the latest study summaries, Medela helps NICU staff and the parents make informed choices during infant feeding development.

Non-oral feeding methods

The delivery of an extremely premature infant is a nutritional emergency. In order to mitigate degrees of starvation in these infants, initial efforts rely heavily on the total or partial parenteral provision of nutrients through an intravenous line. As soon as the infant is ready it progresses to enteral nutrition which involves providing milk through a nasogastric or orogastric tube.

There are risks associated with non-oral feeding methods. These include infection, miscalculations in supply and administration, mechanical difficulties related to line or tube placement as well as the non-natural way in which they provide nutrition. Therefore, it is important to progress the infant to oral feeding as soon as possible.

Transition to oral feeding

The transition to oral feeding is usually supported by non-nutritive sucking devices. Preterm infants who practice non-nutritive sucking during enteral feeding have improved feeding tolerance, accelerated transition from enteral to oral feeding, increased weight gain and a reduced length of stay in hospital. In addition, the readiness of a preterm infant for oral feeding can be assessed to facilitate the transition at an optimal time.

Oral feeding

Part of this transition phase from enteral to oral feeding is the first attempts to feed orally in parallel to tube feeding. From this point until discharge, Medela’s oral feeding portfolio offers a wide range of research based feeding options that support the development of breastfeeding and provide a feeding experience as close to breastfeeding as possible. This includes making oral feeding a positive experience for the infant, parents and NICU personnel.


Schanler R.J., Lau, C., Hurst, N.M., & Smith, E.O. Randomized trial of donor human milk versus preterm formula as substitutes for mothers’ own milk in the feeding of extremely premature infants. Pediatrics 116, 400–406 (2005).

Medeiros, A.M.C. et al. Characterization of the transition technique from enteral tube feeding to breastfeeding in preterm newborns. J Soc Bras Fonoaudiol 23, 57–65 (2011).

Quandt, D., Schraner, T., Ulrich Bucher, H., & Arlettay Mieth, R. Malposition of feeding tubes in neonates: Is it an issue? Pediatr Gastroenterol Nutr 48, 608–611 (2009).

Hurrell, E. et al. Neonatal enteral feeding tubes as loci for colonisation by members of Enterobacteriaceae. BMC Infectious Disease 9, 146 (2009).

Bingham, P.M., Ashikaga, T., & Abbasi, S. Prospective study of non-nutritive sucking and feeding skills in premature infants. Arch Dis Child Fetal Neonatal Ed 95, F194–F200 (2010).

More information