Feeding Practices in Very Preterm and Very Low Birth Weight Infants in an Area Where a Network of Human Milk Banks Is in Place

Abstract

Background: Great variability in enteral feeding practices for very preterm (<32 weeks gestational age-GA) and very low birth weight infants (VLBW; ≤1,500 g) have been reported. We aimed to describe data on enteral feeding in Tuscany (Italy), where a network of 6 donor milk banks is in place.Methods: A 4-years (2012–2015) observational study was performed analyzing the database “TIN Toscane online” on very preterm and VLBW infants. The database covers all 25 hospitals with a neonatal unit.Results: Data concerning the beginning of enteral nutrition were available for 1,302 newborns with a mean (standard deviation) GA of 29.3 (2.9) weeks, while information at the time of full enteral nutrition was available for 1,235 and at discharge for 1,140. Most infants (74.1%) started enteral feeding during the first 24 h of life. Overall, 80.1% of newborns were fed exclusive human milk, donor milk having the larger prevalence of use (66.8%). Few infants (13.3%) started with exclusive mother's milk. Full enteral feeding was achieved using exclusive human milk in most cases (80%). Full enteral feeding was reached earlier in newborns who were fed human milk than in those fed formula, regardless of GA. Sixty-four percent of infants were still fed with any human milk at discharge. When data at the achievement of full enteral nutrition and at discharge were analyzed stratified by the type of milk used to start enteral feeding, newborns initially fed donor milk presented the highest prevalence (91.3%) of exclusive human milk at full enteral feeding, an important period to prevent necrotizing enterocolitis, while no differences were observed at discharge.Conclusions: Donor milk was widely used for newborns during the first hours of life, when mother's milk availability may be quite challenging. Starting enteral nutrition with donor milk was associated with early start of enteral feeding and early achievement of full enteral nutrition without affecting mother lactation. The overall prevalence of human milk at discharge (when donor milk is not available anymore) was high (64%), irrespective of the type of milk used to start nutrition.

Enteral Feeding Practices for Very Preterm and Very Low Birth Weight Infants in Nigeria and Kenya

“…The use of standardized feeding protocols in middle and high income countries ( 18 – 20 ), is associated with earlier achievement of full enteral feeds (thus shorter use of vascular catheters), and reduced rates of neonatal sepsis, NEC, extrauterine growth restriction, and overall, decreased length of stay in the hospital. However, variations in feeding practices across units also occur in high income countries depending on a number of factors including access to facilities such as breastmilk banks ( 21 , 22 ). Currently there is little research on preterm feeding practices in sSA to inform feeding protocols for these at-risk infants ( 13 ).…”

Enhancing early breast milk for sick and preterm neonates admitted at regional referral hospitals in Dar es Salaam, Tanzania

“…However, there is a wide variety of enteral feeding practices for sick and preterm infants since universal feeding guidelines are non-existent [14,15]. Enteral feeding is often delayed in settings without intensive care facilities due to haemodynamic instability and the perceived risk of feeding intolerance or necrotizing enterocolitis (NEC).…”

The Time to Initiate Trophic Feeding and Its Predictors Among Preterm Neonate Admitted to Neonatal Intensive Care Unit, Multicenter Study, Northwest Ethiopia, 2020.

“…This indicates that only a small proportion of preterm neonates started TF within the rst 24 hours of birth. This nding is lower as compared to an observational study in Tuscany (74.1 %), a cohort study in Iran (36%), and New Zealand (60%) (23,31). This nding on the proportion of neonates who started TF within 48 hours is consistent with the nding (63.2%) in a cohort study on preterm neonates in NICU of the Islamic Republic of Iran ( 23), but higher than the nding Nigerian Special Care Baby Unit (40%) (33); and lower than a study nding in Uganda rural hospitals (80%) (28) and New Zealand (80%) (22).…”