Nutrition needs of preterm babies

Sreenath S. Manikanti*

Senior Neonatologist and Pediatrician, Kauvery Hospital, E-City, Bangalore, India

*Correspondence: Tel.: +91 9901541501; email: sreenath.manikanti@gmail.com

More and more preterm babies weighing 600-700 g born in good centres are surviving in India with improvements in the obstetric and NICU services. Abnormal neurodevelopment is one of the major concerns in these preterm survivors. Inadequate early postnatal nutrition appears to result in abnormal neurodevelopment. Therefore, provision of good nutrition becomes vital in striving for better neurodevelopmental outcomes. Inadequate nutrients have been shown to cause short stature, growth failure, neuronal deficits and poor behavioural and cognitive outcomes in these vulnerable babies. The goal of nutritional support in preterm infants was thought to be achieving a postnatal growth rate similar to that of a normal fetus at the same post conceptual age.

Fetus grow rapidly in the third trimester and weight almost triples from second to third trimester. Premature babies are deprived of the rich nutrition that they get from mother’s placenta when they are born early. Although lots advances have been made in terms of NICU care and neonatal nutrition over last two decades, there are still challenges in helping these premature babies to reach the growth velocity that is seen in-utero.

Premature infants have greater nutritional needs in the neonatal period than at any other time of their lives. Preterm babies who are born before 32 weeks are unable to take mother’s feed directly. Besides they often have medical conditions that increase their metabolic energy requirements such as – Respiratory Distress, Hemodynamic instability, Acidosis, Sepsis etc. Most of them require specialized nutrition to start with in the form of Total Parenteral Nutrition (TPN) where Proteins, Lipids, Glucose, microelements & vitamins are given via central lines. Initiation of oral feeds early in these premature babies with expressed mother’s first milk (colostrum) within 1 hour of birth plays a significant role in helping these babies to progress to full feeds early and avoiding infections associated with long term parenteral nutrition. Until these babies develop suck & swallow reflexes to take mother’s feed directly, they are fed with Expressed Breast Milk (EBM) via feeding tube in the NICU. Until they are able to take Direct Breast Feeds measures like Kangaroo Mother’s Care, oromotor stimulation & offering non-nutritive sucking (offering empty breast to suck) play an important role. Until baby starts sucking, these mothers need to be encouraged to pump their breasts every few hours to keep up the milk supply. In the first few days if mother is not able to provide enough Expressed Breast Milk (EBM), these babies can be given Pasteurized Donor Breast Milk. Donor milk is mostly collected from mothers of healthy term babies expressing after a breast feed, less often from mothers of babies who have died or rarely in mothers whose babies are in the neonatal unit & have expressed milk in excess of requirement. Donor milk obtained from term babies is less nutrient rich (especially protein). Pasteurisation reduces the immune factors. In the absence of Mother’s Own Milk (MOM) Donor milk is beneficial in reducing complications such as of NEC (a severe form of gut infection) and improving long term outcomes like cognition, bone mineral content and cardiovascular health compared to formula feeds. Often Breast Milk alone may not be sufficient to meet the nutritional needs of these premature babies. Expressed Breast and Donor Milk can be supplemented with Breast Milk Fortifier to add extra calories, protein, minerals & vitamins.

Once preterm babies reach 32 weeks these premature babies can be assessed for sucking & swallowing and can be initiated on Direct Breastfeeds & Palladia /spoon feeds.

Prevention of Osteopenia of prematurity – is a metabolic bone disease of premature infants as a result of inadequate calcium, phosphorous & vitamin D. It can be prevented with early supplantation of Vitamin D & optimising Calcium & Phosphorous.

Prevention on Anemia of prematurity- Preterm babies are prone to anemia in view of low iron stores, erythropoietin & frequent blood samples which are required to monitor parameters. It can be corrected with Iron & Erythropoietin supplementation & Packed Red Cell Transfusions if required.

Zinc & Vitamin supplementation – Preterm babies need Zinc and Vitamin supplementation when they reach full feeds.

These premature babies need regular growth monitoring and developmental assessments after discharge to ensure good outcome.

 

Dr-Sreenath-S-Manikanti

Dr. Sreenath S. Manikanti

Senior Neonatologist and Pediatrician

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