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Overview

Nutrition in infancy is key for optimal growth of the body and organs such as the brain, and for long-term health and development, as well as later quality of life. (1) This is even more important for infants born preterm compared to those born at term, because preterm infants have much faster weight gain and higher nutrient requirements per kg bodyweight. Also their digestive tract function is often immature, and they regularly require nutritional support (enteral and/or parenteral nutrition). Therefore, professional nutritional care management is very important to prevent the early occurrence of nutrient deficits and growth faltering. Nutritional needs, growth measurements, and feeding practices of the infant need to be regularly assessed by healthcare professionals at the neonatal intensive care unit as well as after discharge, and they need to advise parents on the best nutritional care for the individual preterm infant.

Nutritional care practices vary between hospitals and sometimes even within individual neonatal units. Written protocols based on current evidence can help reduce the requirement for parenteral nutrition, allow more rapid attainment of full enteral feeds, and improved weight gain velocity. (2–8) Although oral feeding may take time to develop after preterm birth, mother’s own milk is the first choice and provision of expressed human milk and later breastfeeding is strongly encouraged.(9,10) Parents should be provided with information and support during this period. However, feeding difficulties may still occur and mothers often report that these persist or even just start after discharge from hospital. (11) Caregivers including physicians, nurses and the nutrition support team, play a central role in supporting parents in the feeding of their preterm or ill infant, including identifying infant feeding cues, and supporting the transition from hospital to home. (12,13)

The Topic Expert Group on Nutrition develops standards relating to the special feeding requirements of preterm and sick infants during their stay in the hospital and after discharge.

Sources

  1. Koletzko B, Poindexter B, Uauy R, editors. Nutritional care of preterm infants: scientific basis and practical guidelines. Basel: Karger; 2014. 110:1-314. (World review of nutrition and dietetics). doi: 10.1159/000358453.
  2. Ehrenkranz RA, Das A, Wrage LA, Poindexter BB, Higgins RD, Stoll BJ, et al. Early nutrition mediates the influence of severity of illness on extremely LBW infants. Pediatr Res. 2011 Jun;69(6):522–9.
  3. Ehrenkranz RA. Nutrition, growth and clinical outcomes. World Rev Nutr Diet. 2014;110:11–26.
  4. McCallie KR, Lee HC, Mayer O, Cohen RS, Hintz SR, Rhine WD. Improved outcomes with a standardized feeding protocol for very low birth weight infants. J Perinatol Off J Calif Perinat Assoc. 2011 Apr;31 Suppl 1:S61-67.
  5. Rochow N, Fusch G, Mühlinghaus A, Niesytto C, Straube S, Utzig N, et al. A nutritional program to improve outcome of very low birth weight infants. Clin Nutr Edinb Scotl. 2012 Feb;31(1):124–31.
  6. Patole SK, de Klerk N. Impact of standardised feeding regimens on incidence of neonatal necrotising enterocolitis: a systematic review and meta-analysis of observational studies. Arch Dis Child Fetal Neonatal Ed. 2005 Mar;90(2):F147-151.
  7. Gephart SM, Hanson CK. Preventing necrotizing enterocolitis with standardized feeding protocols: not only possible, but imperative. Adv Neonatal Care Off J Natl Assoc Neonatal Nurses. 2013 Feb;13(1):48–54.
  8. Senterre T. Practice of enteral nutrition in very low birth weight and extremely low birth weight infants. World Rev Nutr Diet. 2014;110:201–14.
  9. Boyle EM, Johnson S, Manktelow B, Seaton SE, Draper ES, Smith LK, et al. Neonatal outcomes and delivery of care for infants born late preterm or moderately preterm: a prospective population-based study. Arch Dis Child Fetal Neonatal Ed. 2015 Nov;100(6):F479-485.
  10. Hwang SS, Barfield WD, Smith RA, Morrow B, Shapiro-Mendoza CK, Prince CB, et al. Discharge Timing, Outpatient Follow-up, and Home Care of Late-Preterm and Early-Term Infants. PEDIATRICS. 2013 Jul 1;132(1):101–8.
  11. Thoyre SM. Mothers’ ideas about their role in feeding their high-risk infants. J Obstet Gynecol Neonatal Nurs JOGNN. 2000 Dec;29(6):613–24.
  12. Brown LF, Griffin J, Reyna B, Lewis M. The development of a mother’s internal working model of feeding. J Spec Pediatr Nurs JSPN. 2013 Jan;18(1):54–64.
  13. Swanson V, Nicol H, McInnes R, Cheyne H, Mactier H, Callander E. Developing maternal self-efficacy for feeding preterm babies in the neonatal unit. Qual Health Res. 2012 Oct;22(10):1369–82.

Standards

Effective implementation of early parenteral feeding

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Establishment of enteral feeding in preterm infants

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Family education and training on infant feeding in the unit and after discharge

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Feeding of late preterm infants

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Monitoring growth in the neonatal unit

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Providing mother’s own milk (MOM) for preterm and ill term infants

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The role of human milk banks

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The role of nutrient supplements for preterm infants

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The role of preterm formula

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Written standards of nutritional practice

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