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Homepage > Science in a capsule > Growth & metabolism > Giving preterm infants the best chance to thrive into the childhood years and beyond

Giving preterm infants the best chance to thrive into the childhood years and beyond

Around 12% of babies in Africa are born prematurely1. Premature babies have very different nutritional needs to full-term infants as they need to attain the growth that would have occurred in utero, as well as achieve functional development2. Inspired by breast milk, we are committed to delivering products to help preterm infants thrive.

Preterm infants face a multitude of challenges, including respiratory complications, poor thermoregulation, problems with the gastrointestinal (GI) tract, low body stores of many nutrients and other medical complications3.

The final trimester of pregnancy is particularly important for fetal development4,5. This is a time of extensive development of organs and the immune system and the establishment of nutrient stores 4-6. Preterm infants must complete much of this development ex utero7.

Advantages of breast milk

Breast milk is the best source of nutrition for preterm infants and offers many significant benefits to both infant and mother. It provides8:

  • Protection from infections
  • An improved feeding tolerance
  • Reduced risk of necrotising enterocolitis (NEC)
  • Digestive enzymes
  • Benefits for baby’s gastrointestinal (GI) tract
  • Psychological benefits for mother

However, many preterm infants may have higher nutritional requirements than breast milk alone can provide2,8. Also, the daily intake volume that a preterm infant can tolerate is often not enough to cover its increased nutritional needs9-11. The differences between the nutritional requirements of a preterm infant and the nutrition provided in breast milk highlight the need for additional supplementation in the form of either a human milk fortifier and/or a protein supplement.

The role of prebiotic oligosaccharides

Prebiotic OS (oligosaccharides) are non-digestible oligosaccharides that occur naturally in breast milk12. Upon ingestion, they serve a number of functions13-17:

First, they pass through the stomach and small intestine. The prebiotic oligosaccharides mixture is then metabolised to produce short-chain fatty acids (SCFA) in the large intestine. SCFA promote a thicker mucous layer lining in the intestine and also lower pH levels in the intestine.

The presence of prebiotic oligosaccharides prevents harmful bacteria from attaching to the intestinal lining and entering the bloodstream. They also encourage the growth of friendly bacteria and feed the beneficial bifidobacteria in the gut.

The role of beta-palmitate

Dietary lipids, or fats, provide preterm infants with a large proportion of energy, with essential fatty acids and lipid soluble vitamins8.

The structure of fats in breast milk consists of a glycerol group with three fatty acids attached, called a triglyceride. When palmitic acid is in the beta (β) position, lipids are metabolized more efficiently by infants18. This provides several beneficial effects, including better fat absorption, improved calcium absorption, easier digestion and softer stools18-22.

The role of Long-Chain PolyunSaturated Fatty Acids (LCPUFAs)

LCPs are important for the healthy development of an infant’s brain, eyes and nervous system23-26. For preterm infants, LCPs, such as docosahexaenoic acid (DHA) and arachidonic acid (AA), are conditionally essential as the third trimester is a critical period for brain growth27-31.

The ability to make DHA and AA in the body is very limited in the first few months of life27-29. Preterm infants that are fed formulas without LCPs develop poor DHA & AA status32-36. Nutrient-enriched formula with LCPs, DHA & AA is recommended for preterm and post-discharge feeding2,8-10,37,38.

It is recognised that preterm infants are particularly vulnerable and have different nutritional needs to full-term infants. Breast milk is the best source of nutrition as it provides significant advantages, including key ingredients, such as prebiotics, milk fats and LCPs. However, in instances where breast milk is not available or the production of breast milk is not sufficient to meet the preterm infant’s specific requirements, supplementation is recommended.

References

  1. Chawanpaiboon, Saifon, et al. Global, regional, and national estimates of levels of preterm birth in 2014: a systematic review and modelling analysis. The Lancet Global Health1 (2019) : e37-e46.
  2. Agostoni, C., et al. Enteral Nutrient Supply for Preterm Infants: Commentary from the European Society for Paediatric Gastroenterology, Hepatology, and Nutrition Committee on Nutrition. J Pediatr Gastroenterol Nutr. 50 (2010) : 85-91.
  3. À quels problèmes de santé les bébés prématurés sont-ils confrontés ? 2013. Disponible sur : http://www.who.int/features/qa/preterm_health_challenges/fr/ [consulté en avril 2016].
  4. Waterland, R.A., Michels, K.B. Epigenetic epidemiology of the developmental origins hypothesis. Ann Rev Nutr. 27 (2007) : 363-388.
  5. Zeisel, Z.H. Epigenetic mechanisms for nutrition determinants of later health outcomes. Am J Clin Nutr. 89.5 (2009) : 1488s-1493s.
  6. Embleton, N. Enteral nutrition for preterm infants: translating ESPGHAN guidelines into practice. 7.6 (2011) : 187-190.
  7. Mihatsch, W.A., Högel, J., Pohlandt, F. The abdominal circumference to weight ratio increases with decreasing body weight in preterm infants. Acta Paediatr. 93.2 (2004) : 273-274.
  8. Koletzko, B., et al. Nutritional Care of Preterm Infants. Scientific Basis and Practical Guidelines, World Rev Nutr Diet, Karger 110 (2014) : 304-305.
  9. Tsang, R.C., et al. Nutrition of the preterm infant; scientific basis and practical guidelines. 2e éd. Digital Educational Publishing Inc, Cincinnati 2005.
  10. Klein, C.J. Nutrient requirements for preterm infant formulas. J Nutr 132 (2002) : 1395S-1549S.
  11. Geigy Scientific Tables. (1975). 7e éd. Bâle, Suisse, Ciba-Geigy, Ltd.
  12. Gibson, G.R., Roberfroid, M.B. J Nutr 125 (1995) : 1401.
  13. Oozeer, R., van Limpt, K., Ludwig, T., et al. Intestinal microbiology in early life: specific prebiotics can have similar functionalities as human-milk oligosaccharides. Am J Clin Nutr. (Août 2013). 98.2 : 561S-71S.
  14. Newburg, D.S. Oligosaccharides in human milk and bacterial colonization. J Pediatr Gastroenterol Nutr. 30.2 (2000) : S8-17.
  15. Kunz, C., et al. Nutritional and biochemical properties of human milk, Part I: General aspects, proteins, and carbohydrates. Clin Perinatol. 26 (1999) : 307-333.
  16. Kunz, C., et al. Oligosaccharides in human milk: structural, functional, and metabolic aspects. Annu Rev Nutr. 20 (2000) : 699-722.
  17. Boehm, G., et al. Structural and functional aspects of prebiotics in infant nutrition. J Nutr.9 (2008) : S1818-28.
  18. Bar-Yoseph, F., et al. Review of sn-2 palmitate oil implications for infant health. Prostaglandins Leukot Essent Fatty Acids4 (2013) : 139-143.
  19. Carnielli, V.P., et al. Feeding premature newborn infants palmitic acid in amounts and stereoisomeric position similar to that of human milk: effects on fat and mineral balance. Am J Clin Nutr. 61.5 (1995) : 1037-42.
  20. Carnielli, V.P., et al. Structural position and amount of palmitic acid in infant formulas: effects on fat, fatty acid, and mineral balance. J Pediatr Gastroenterol Nutr. 23.5 (1996) : 553-60.
  21. Kennedy, K., et al. Double-blind, randomized trial of a synthetic triacylglycerol in formula-fed term infants: effects on stool biochemistry, stool characteristics, and bone mineralization. Am J Clin Nutr. 70.5 (1999) : 920-7.
  22. Quinlan, P.T., et al. The relationship between stool hardness and stool composition in breast- and formula-fed infants. J Pediatr Gastroenterol Nutr. 20.1 (1995) : 81-90.
  23. Koletzko, B., et al. The roles of long-chain polyunsaturated fatty acids in pregnancy, lactation and infancy: review of current knowledge and consensus recommendations. J Perinatal Med. 36 (2008) : 5-14.
  24. Willatts, P., et al. Effect of long-chain polyunsaturated fatty acids in infant formula on problem solving at 10 months of age. Lancet. 352 (1998) : 688-91.
  25. European Food Safety Authority Panel on Dietetic products, Nutrition and Allergies. Scientific substantiation of a health claim related to docosahexaenoic acid (DHA) and arachidonic acid (ARA) and visual development pursuant to Article 14 of Regulation (EC) No 1924/2006. The EFSA Journal 941 (2009) : 1-14.
  26. Birch, E.E., et al. Visual acuity and the essentiality of docosahexaenoic acid and arachidonic acid in the diet of term infants. Pediatr Res. 44.2 (1998) : 201-9.
  27. Carnielli, V.P., et al. Medium-chain triacylglycerols in formulas for preterm infants: effect on plasma lipids, circulating concentrations of medium-chain fatty acids, and essential fatty acids. Am J Clin Nutr. 64 (1996) : 152-8.
  28. Makrides, M., et al. A randomized trial of different ratios of linoleic to alpha-linolenic acid in the diet of term infants: effects on visual function and growth. Am J Clin Nutr. 71 (2000) : 120-9.
  29. Sauerwald, T.U., et al. Intermediates in endogenous synthesis of C22:6 omega 3 and C20:4 omega 6 by term and preterm infants. Pediatr Res. 41 (1997) : 183-7.
  30. Dobbing, J., Sands, J. Comparative aspects of the brain growth spurt. Early Hum Dev. 3.1 (1979) : 79-83.
  31. Lauritzen, L., et al. The essentiality of long chain n-3 fatty acids in relation to development and function of the brain and retina. Prog Lipid Res. 40.1 et 40.2 (2001) : 1-94.
  32. Carlson, S.E., et al. Long-term feeding of formulas high in linolenic acid and marine oil to very low birth weight infants: Phospholipid fatty acids. Pediatr Res. 30.5 (1991) : 404-412.
  33. Carnielli, V.P., et al. Long-chain polyunsaturated fatty-acids (LCP) in low-birth-weight formula at levels found in human colostrum. Pediatric Research. (1994). Williams & Wilkins, 351 West Camden St, Baltimore, Maryland 21201-2436.
  34. Carnielli, V.P., et al. Chain elongation and desaturation of linoleic (LL) and linolenic (LN) acid in the vlbw infant-effect of dietary long-chain polyunsaturated fatty-acids (LCP). Pediatric Research. (1994). Williams & Wilkins, 351 West Camden St, Baltimore, Maryland 21201-243.
  35. Foreman-Van Drongelen, M.M., et al. Long-chain polyene status of preterm infants with regard to the fatty acid composition of their diet: Comparison between absolute and relative fatty acid levels in plasma and erythrocyte phospholipids. Br J Nutr. 73.3 (1995) : 405-422.
  36. Foreman-van Drongelen, M.M., et al. Influence of feeding artificial-formula milks containing docosahexaenoic and arachidonic acids on the postnatal long-chain polyunsaturated fatty acid status of healthy preterm infants. Br J Nutr. 76.5 (1996) : 649-667.
  37. American Academy of Pediatrics Committee on Nutrition. Nutritional needs of the preterm infant. Dans : KLEINMAN, R. & GREER, F. (dir.) Pediatric Nutrition. Elk Grove Village, Illinois : American Academy of Pediatrics, 2014
  38. Aggett, P.J., et al. Feeding preterm infants after hospital discharge: a commentary by the ESPGHAN Committee on Nutrition. J Pediatr Gastroenterol Nutr. 42 (2006) : 596-603

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