Recommendations for feeding a preterm baby
Preterm baby postnatal growth restriction (also referred to as extrauterine growth restriction) is a common phenomenon due to the many challenges in feeding this vulnerable group.1–3 Babies most at risk include those born very prematurely and the critically ill.
The last trimester of pregnancy is a period when extensive development of the neural tract occurs.4 A consequence of prematurity and postnatal growth restriction is impaired neurodevelopment.4–6 Greater growth deficits seem to be associated with greater neurodevelopmental impairment.
Therefore, the most important objective of nutritional management of the preterm baby infant is the prevention of growth failure in order to protect the infant’s brain.5 More recently, research has demonstrated an association between increased nutrients such as protein and energy and positive developmental outcome.7
Recommendations for feeding in hospital
The 2010 European Society for Pediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) recommendations on enteral nutrient supply for preterm infants:8
‘The preferred food for premature infants is fortified human milk from the infant’s own mother, or, alternatively, formula designed for premature infants.’
Fortified breast milk
The advantages of breast milk are especially important for a preterm baby. Breast milk has been shown to confer improved short- and long-term outcomes in regards to:
- Lower rates of necrotising enterocolitis (NEC)9
- Neurodevelopmental advantages10
ESPGHAN recommends that preterm breast milk should be fortified8 – this is to correct for the decreasing protein content of breast milk with ongoing lactation.11 The primary outcomes of feeding fortified breast milk are that the baby receives the benefits of breast milk while its nutritional status and growth is improved.12
Formula designed for preterm infants
ESPGHAN recommends that if breast milk is unavailable, a formula designed for preterm infants should be used.8 Protein and energy are vital in the management of growth – the ESPGHAN recommendations include guidance on the macro- and micronutrient composition of preterm infant formula.8
ESPGHAN recommended intakes for energy and protein requirements of preterm infants:8
Infant weight | Energy (kcal/kg/d) | Protein (g/kg/d) | Protein (g/100kcal) | Protein energy ratio (PER) |
|---|---|---|---|---|
Preterm infants <1 kg | 110–135 | 4–4.5 | 3.6–4.1 | 14.4–16.4% |
Preterm infants 1–1.8 kg | 110–135 | 3.5–4 | 3.2–3.6 | 12.8–14.4% |
Recommendations for feeding preterm infants on discharge
The 2006 ESPGHAN guidance on feeding preterm infants on discharge from hospital:13
‘Infants discharged with a subnormal weight for postconceptional age are at increased risk of long-term growth failure...’
The following recommendations are made:
- Breastfed preterm infants on hospital discharge should receive fortified human milk to provide an adequate nutrient supply
- Formula-fed preterm infants on hospital discharge ‘should receive special post-discharge formula with high contents of protein, minerals and trace elements as well as a long-chain polyunsaturated fatty acid supply, at least until a postconceptional age of 40 weeks, but possibly until about 52 weeks postconceptional age’
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