Nutrition for Premature Infants

Premature infants, or preemies, are not uncommon, so don’t panic if you have a preemie. Caring for a preemie will be more challenging, but by providing him with the right nutrition, he has a much higher chance to grow up normally.

Preemies are delivered before 37 weeks of gestation, while deliveries after that are considered term. Globally, it is estimated that 1 in 10 infants are born prematurely. One of the common mothers’ concerns on preemie is their nutrition and growth.

Breast milk right from the start

Preemies often are low birth weight (2.5kg and below), and have special nutritional requirements as their bodies have not yet stored sufficient energy and nutrient reserves, They also suffer from illnesses related to immaturity such as acute lung disease.

It is of great help if moms are able to provide colostrum (the first stage of breast milk) as early feeds to their preemie as soon as possible. This will help to prime and protect their gut and colostrum also contains antibodies which help protect your preemie from infections. In many developed countries, when moms cannot provide their own breast milk, they can opt to use donor breast milk, which is instituted and handled by accredited milk banks.

Preemies delivered before 34 weeks tend to have oral feeding difficulties such as sucking, swallowing and coordinating with breathing, and impaired gut motion due to their immature bodily functions. Thus, they are usually fed via a tube directly into their stomachs in the first week or two. Also, a special solution called total parenteral nutrition, which contains a blend of nutrients to support their energy needs and growth, may also be infused into the blood stream.

Unlike term infants, preemies have a higher energy and nutrient requirement. When the preemie has achieved sufficient breast milk feeds, your doctor may prescribe adding of human milk fortifiers (HMF) to your expressed breast milk in order to ensure that your preemie receives the optimal nutrition needed to ‘catch up’ on growth. However, if the supply of breast milk is insufficient, a special preterm formula may be supplemented instead.

Bringing preemie home

In Malaysia, most hospitals allow preemies to be discharged when they show good consistent weight gain, have reached at least 1.8kg, are able to take milk from the breast or bottle, and have reached a corrected age of 36 weeks.

Proper nutrition is important to ensure adequate overall growth throughout and to reduce the risk of growth faltering. Most importantly, continue breastfeeding your preemie. In some cases, your preemie may still require HMF. This is especially true in the case of very low birth weight (VLBW) infants that weigh below 1500g at birth. If your breastmilk supply is still insufficient, you may need to add on a post-discharge formula (PDF) to top-up on the feeding.

However, if breastfeeding is not an option or if there is no breast milk available at all, your doctor may recommend the use of PDF alone. PDF is meant for premature, low birth weight infants and is used after hospital discharge within the first year of life, until normal growth (age-corrected) is achieved.

Keep a close eye on his growth

Monitor and keep track of your preemie’s growth closely. Certain nutrients are important to help him catch up on his growth. He needs a higher intake of energy, protein, minerals, and vitamins.

You probably know the benefits of omega-3 and omega-6 polyunsaturated fatty acids such as docosahexaenoic acid (DHA) and arachidonic acid (AA); they are important for eye and brain development. Although many milk formulae contain these nutrients, breast milk is superior as it has the correct ratio for your preemie individual needs.

In larger preemies, exclusive breastfeeding alone may be enough. However, follow-up in clinics is recommended for periodic checks to ensure that your preemie has sufficient nutrients to support bone growth.

To keep in mind

Breastmilk is still the BEST choice for all infants. If your preemie’s growth is satisfactory, your doctor may recommend that you switch to exclusive breastfeeding and stop adding of HMF. If not breastfeeding, PDF use may be substituted with a normal milk formula.

At 6 months corrected age, start complementary feeding to meet the nutritional and growth requirements. Importantly, continued breastfeeding within the first year is strongly encouraged. Note that while good and adequate nutrition is necessary for proper growth and development, an excess of nutrition can lead to obesity. This will have a negative impact on later health in your preemie’s life.

Lastly, do not miss any clinic appointments! These visits will allow your doctor to monitor your preemie for proper growth and development. You can also consult with your doctor for advice on providing the right nutrition, with the right amount, at the right time for your precious’ healthy growth.

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