Authors
Lapillonne A, Koletzko B, Fewtrell MS, Embleton ND, Jonat S, van Goudoever JB, Gruszfeld D, McNulty A, Szitanyi P
Preterm infants and parents
Healthcare professionals, neonatal units, hospitals, and health services
Preterm infants are given supplements to reduce nutritional deficits.
Fortified human milk and preterm formulas in adequate volume meet most nutrient requirements even of very preterm infants. (1) However, the intake of some macro- or micronutrients is often inadequate. (2,3) This may result from both the specific medical condition and poor nutritional intake. A variety of dietary supplements can bridge the gap between achieved nutrient provision and calculated requirements. Extremely preterm infants can have specific protein needs above those provided by fortified human milk or preterm formula and may require a modular protein supplement. (4) Preterm infants with a high energy expenditure due to ongoing disease (e.g. bronchopulmonary dysplasia or heart failure) may require added energy supplements. (5)
Fat soluble vitamins, iron, zinc and sodium are supplements widely used during hospitalisation. (5) Vitamin supplements may be appropriate for infants on low daily volume of fortified milk or preterm formula. Total vitamin D intake is usually suboptimal even with adequate feeding, and vitamin D supplements are generally provided to all preterm infants. (6) Infants with severe cholestasis require additional fat soluble vitamins. (7) Iron may be needed in amounts >2 mg/kg as often provided by fortified human milk or preterm formula, especially in extremely preterm infants and in those receiving erythropoietin therapy. (8) Other possible supplements that may be needed include calcium, phosphorus, potassium (high urinary losses with diuretic therapy), sodium (high urinary losses in preterm infants) and zinc (enterostomy losses).
Supplements are generally started when full enteral feeding is achieved and continued after discharge as needed. (9) Surveillance of blood markers may be required based on an individual assessment. (10)
For parents and family
B (High quality)
Patient information sheet1*
B (High quality)
Patient information sheet1*
For healthcare professionals
B (High quality)
Guideline
B (High quality)
Training documentation
A (Moderate quality)
Audit report2
For neonatal unit
B (High quality)
Guideline
For hospital
B (High quality)
Training documentation
B (High quality)
Audit report2
For health service
B (High quality)
Guideline
B (Moderate quality)
Guideline
1The indicator ‘patient information sheet’ is an example for written, detailed information, in which digital solutions are included, such as web-based systems, apps, brochures, information leaflets, and booklets.
2The indicator ‘audit report” can also be defined as a benchmarking report.
*The TEG Nutrition very much supports the need of good communication with families and regular sharing of key information, but it is not in favour of sharing information on each standard by a “parent information sheet”, which is the term chosen by the Chair Committee. In our view, sharing multiple parent information sheets bears the risk of overloading families with a plethora of written information during a stressful time period, which may not be very helpful. We suggest to consider other means of sharing information.
For parents and family
N/A
For healthcare professionals
N/A
For neonatal unit
N/A
For hospital
N/A
For health service
B (Moderate quality)
For parents and family
For healthcare professionals
For neonatal unit
For hospital
For health service
November 2018 / 1st edition / next revision: 2023
Recommended citation
EFCNI, Lapillonne A, Koletzko B et al., European Standards of Care for Newborn Health: The role of nutrient supplements for preterm infants. 2018.
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