Preterm nutritional needs and feeding challenges – A guide for healthcare professionals

Several studies have shown that growth failure in preterm infants affects health in later life and compromises brain development¹^,². Avoiding growth failure is a central challenge when it comes to preterm nutrition¹–³.

Preterm infants have increased nutritional needs, particularly if they are to achieve the growth velocity of a child that grows full-term in its mother’s womb⁴^,⁵. These requirements are much higher than those of a term-born peer⁴⁻⁶. Medical associations, such as the European Society for Gastroenterology, Hepatology and Nutrition (ESPGHAN)⁶ and the American Academy of Pediatrics (AAP)⁷, as well as neonatal experts⁸, address these requirements by giving specific recommendations for premature infants born weighing less than 1,000g, less than 1,500g and less than 1,800g. All the associations acknowledge that protein is a key nutrient in avoiding growth failure, as long as enough energy is provided⁶⁻⁸.

Breast is best

In line with the World Health Organization (WHO) we believe that human milk is the best nutrition for preterm infants⁹. Breastfeeding and human milk are the preferred feeding modes and offer the best nutrition for infants¹⁰⁻¹³.

The composition of human milk is highly variable and tailored to the individual nutritional needs of an infant¹⁴⁻¹⁶. For preterm infants on parenteral feeds, trophic feeding with human milk soon after birth is recommended to prepare the intestine for enteral feeding³^,¹¹^,¹².

Benefits of maternal human milk

Beyond the benefits of breastfeeding known for full-term infants¹⁷, feeding preterm babies with human milk:

• Offers immune protection against infection³^,¹¹^,¹²
• Reduces the risk of necrotising enterocolitis (NEC)³^,¹¹^,¹²
• Prepares the gut for enteral feeding³^,¹¹^,¹²
• Supports healthy gut development³^,¹¹^,¹²
• Provides enzymes for fat absorption¹²
• Is associated with improved neurocognitive development³^,¹¹^,¹²
• Is well tolerated³^,¹¹^,¹² and personalised to the mother-infant¹⁵^,¹⁶

Colostrum, a pre-milk fluid rich in immunoglobulins and immune cells that is produced during the first 24-48 hours postpartum, is especially important for immune protection and gut maturation and should never be discarded¹².

Donor human milk

If own mothers milk (OMM) is not available, donor human milk (DHM) from milk banks is the next preferred alternative for preterm infant feeding¹³. However, as with OMM, DHM is not nutrient enriched enough to meet the unique requirements of extreme and very premature infants. In these cases, fortification (i.e. adding macro- and micronutrients to human milk or a multicomponent Human Milk Fortifier (HMF)) is required⁶^,⁸^,¹⁸.

What is fortification?

Human milk fortification is associated with improved growth and brain development³^,⁶^,⁸^,¹⁰⁻¹³^,¹⁸. Infants born weighing less than 1,800g are recommended to feed with fortified human milk enriched in energy, macronutrients, minerals and vitamins⁶^,⁸ in order to achieve growth rates similar to those of the fetus. However, infants born weighing less than 1,000g and/or those born small-for-gestational age may need an even faster weight gain for recovering growth¹⁹^,²⁰ as they have even higher protein and energy needs⁶^,⁸^,⁹^,¹⁹.

40 years of early life science

Nutricia Early Life Nutrition has over 40 years of breast milk expertise with a dedicated team of around 250 specialist scientists collaborating with hospitals, laboratories and universities worldwide to ensure we are leaders in this field. At Nutricia Early Life Nutrition, science is at the heart of our nutrition and health commitment to help healthcare professionals support parents during the first 1,000 days of life. Our research and innovation delivers evidence-based nutritional solutions to support a child’s lifelong health, combining our Early Life Nutrition expertise with years of professional experience to develop a portfolio of products to support the nutritional needs of mothers, mothers-to-be and their babies.

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