How Nutritional Care in the NICU Helps Preterm Babies: Insights from an Indian Study

If your baby arrived earlier than expected, you would probably feel overwhelmed. The NICU is an unfamiliar, intimidating place - full of monitors, alarms, wires, and medical terms no one prepared you for. You may be wondering if your baby is okay, what the doctors are doing, and when you will finally be able to take your little one home.

You are not alone feeling this way. In India, about 13 out of every 100 babies are born preterm, according to Indian demographic health survey data published in 2025. That means lakhs of families go through this experience every year - the same anxiety, the same questions, the same waiting.

One of the things that can feel especially helpless is not being able to feed your baby the way you imagined. In the NICU, feeding decisions are made by the medical team based on factors like your baby’s weight, age, and condition. Understanding what they are doing and why can help you feel a little more in control during a time when so much feels out of your hands.

 A study was conducted (Health Economic Research Outcomes, the HERO study) with experts across five tertiary care hospitals in Mumbai, Kolkata, Bangalore and Surat to understand how doctors approach feeding in the NICU and what difference it makes for preterm babies. This article shares what was found, in a way that we hope helps you make sense of your baby’s care.
 

What Is a Human Milk Fortifier and Why Might Your Baby Need One?

You already know that breast milk is the most important nutrition for your baby. Organisations like the World Health Organization (WHO), the Indian Academy of Pediatrics (IAP) & National Neonatology Forum of India (NNFI) say the same thing - breast milk is the ideal food for newborns.

But here is something that can feel confusing and even upsetting to hear babies born very early, especially those with very low birth weight & extreme preterm babies, breast milk alone may sometimes not be enough. It is not that your milk is inadequate- it is that your baby’s needs are unusually high. Preterm babies need more protein, calcium, phosphate, and energy than full-term babies because they are trying to do outside the womb what they were supposed to do inside it.

 Professor Nick Embleton, a neonatologist with >35 years' experience in the NICU & extensive track record in research & teaching about neonatal nutrition, in his recent article says, preterm babies need more energy than cycling the Tour de France!

A human milk fortifier, or HMF, is something the medical team may add to your expressed breast milk to increase its nutritional content. It does not replace your milk. It builds on it. Think of it as giving your milk a boost so it can do even more for your baby.

The decision to use an HMF is always made by your baby’s neonatologist. It depends on various factors such as the baby’s weight, how early they were born, and how they are responding to feeds.

If your baby’s doctor has recommended fortification, it does not mean your breast milk is not enough. It means your baby needs a little extra help - and your milk is still the foundation of everything they are getting. Breast milk is the best for your baby. In addition to nutrients for growth and development, it also contains many components (eg, antibodies, growth factors) that help protect against infections and support the baby’s immune development.

How Does Fortified Feeding Support Weight Gain in Preterm Babies?

When your baby is in the NICU, you will hear a lot about weight gain. Every gram matters. The nurses will weigh your baby regularly, and those numbers will start to mean everything to you.

Weight gain in preterm babies is not just about getting bigger. It is connected to brain development, immune strength, lung maturity, and ultimately, when your baby is ready to come home. Slow weight gain can mean a longer stay. Consistent, steady gain is one of the clearest signs that your baby is heading in the right direction.

In the study, doctors reported that preterm babies receiving fortified breast milk gained additional ~ 10 to 20 grams per kilogram per day, compared to those on unfortified feeds. 

To put that in perspective: if your baby weighs 1.0 kg and is gaining at the higher end, that is about 30 grams a day - roughly the weight of two tablespoons of dal. It may sound small, but for a baby who arrived weeks early, that daily gain is a significant step toward going home.

Can Fortified Feeds Reduce Time Spent in the NICU?

Every parent in the NICU has the same question at the back of their mind, all day, every day: when can we go home?

The answer depends on many things - your baby’s breathing, body temperature regulation, feeding ability, and yes, weight gain. Nutrition is one of the factors the medical team watches closely when deciding if your baby is ready for discharge.

In the study, doctors reported that the average NICU stay for a baby receiving unfortified feeds was approximately 15 days more. For babies receiving fortified breast milk, that number came down by approximately 9 days - a reduction of around 40%.

Earlier discharge does not mean the doctors are rushing your baby out. It means your baby is ready to be taken home. 

What Does This Mean for Families Financially?

This is the part no one wants to talk about, but every NICU family thinks about. The emotional toll of having a pre-term baby is enormous. The financial toll can be just as heavy.

NICU care everywhere & in India is expensive, but it is more visible in India as parents have to shell out the money, but in other developed countries every penny saved is useful elsewhere. Out-of-pocket costs - transport, food, lost wages, accommodation if you have travelled from another city - add up on top of the hospital bills. For many families, financial stress compounds the emotional stress in ways that are hard to describe.

These numbers come from five tertiary care centers in metro cities. Your actual costs will depend on your city, hospital type, and whether it is a government or private facility. But having a sense of the numbers can help you plan and have informed conversations with the hospital.

It is also worth knowing that the first four days in the NICU tend to be the most expensive, accounting for about 45% of total costs because of intensive monitoring and stabilisation. As your baby improves, the daily costs come down. So, the actual savings from earlier discharge will vary depending on your baby’s specific situation.

It is important to note that these are physician-reported estimates from a survey, not individually tracked patient outcomes. As parents, you should discuss your baby’s specific situation with your medical team rather than applying these averages directly.

Questions to Ask Your Baby’s NICU Team

The NICU can feel like a place where things happen to your baby, and you just have to watch. But you have every right to understand what is going on. Asking questions does not make you difficult - it makes you involved.

You may not get the answers you want to hear. The medical team may not be able to give you a firm date for discharge, and that uncertainty is one of the hardest parts. But understanding the process -even a little - can help you feel less like a bystander and more like a partner in your baby’s care.