PAEDIATRIC
FEEDING PREMATURE INFANTS Dr Emma Derbyshire Independent Consultant Emma heads Nutritional Insight Ltd, an independent consultancy to industry, government and PR agencies. An avid writer for academic journals and media, her specialist areas are maternal nutrition, child nutrition and functional foods. www.nutritionalinsight.co.uk @DrDerbyshire
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There is general information available about how to feed infants per se. But what if an infant is born premature? How do feeding recommendations vary? Publications don’t tend to include distinct recommendations for preterm infants and there is a need to separate guidelines for this group of children. This article takes a look at what information is available and how to first feed premature infants. A premature infant is typically defined as a baby that is born before 37 weeks of pregnancy.1 So there can be different ‘levels’ of prematurity as such. Typically, healthy preterm infants born from 34 completed weeks and onwards can be weaned using the same feeding guidelines as full-term infants.1 For those who are born before this and who are premature or sick, BLISS feeding guidance needs to be followed.2 This article focuses on how milk and solid foods are best introduced to preterm infants. MILK FEEDS
If possible, breast milk is a perfect first food for preterm infants. This is thought to help protect the baby from infections, including those of the gut which they are naturally more predisposed to.3
It is also easy to digest and contains the key flavours, hormones, nutrient and growth factors that a young baby needs.3 If it is not possible to feed from the breast, support and advice should be provided to help mothers express their milk.3 If a preterm baby is bottled fed, the healthcare team usually prescribe preterm formulas. Most infants tend to have moved on to full-term formulas by the time they are discharged from hospital.4 The range of nutrients that a premature baby has needs to be carefully balanced to suit their immature digestive system whilst meeting the needs of their growing body.4 Research shows that a number of key nutrients, including the likes of iron, zinc, copper, selenium, manganese, iodine,
Table 1: Nutritional differences - full term versus preterm13 Term infant 37-40 weeks gestation, where intrauterine environment has been appropriate Body weight of >2.5kg, doubling within the first year of life Skeleton to protect from the physical environment, and by one year of age, supporting the infant Musculature sufficiently developed to allow inflation of the lungs, breastfeed and move Insulating layer of fat around organs and under skin, also providing protection and an energy reserve Sufficient iron stores for first three to four months Structurally and physiologically mature digestive system to process nutrition A brain that will co-ordinate processes and communicate its needs
Preterm infant 24 weeks gestation Body weight of around 600g Skeleton inadequately calcified and at high risk of fracture Musculature insufficiently developed to inflate lungs No adipose stores to provide protection, insulation or energy reserves No iron stores A digestive system whose structure cannot support the transit of food and has not developed adequate enzyme support to digest adequate nutrition Primitive and underdeveloped brain
www.NHDmag.com February 2018 - Issue 131
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