Feeding Preterm Infants After Hospital Discharge

Abstract

Survival of small premature infants has markedly improved during the last few decades. These infants are discharged from hospital care with body weight below the usual birth weight of healthy term infants. Early nutrition support of preterm infants influences long-term health outcomes. Therefore, the ESPGHAN Committee on Nutrition has reviewed available evidence on feeding preterm infants after hospital discharge. Close monitoring of growth during hospital stay and after discharge is recommended to enable the provision of adequate nutrition support. Measurements of length and head circumference, in addition to weight, must be used to identify those preterm infants with poor growth that may need additional nutrition support. Infants with an appropriate weight for postconceptional age at discharge should be breast-fed when possible. When formula-fed, such infants should be fed regular infant formula with provision of long-chain polyunsaturated fatty acids. Infants discharged with a subnormal weight for postconceptional age are at increased risk of long-term growth failure, and the human milk they consume should be supplemented, for example, with a human milk fortifier to provide an adequate nutrient supply. If formula-fed, such infants should receive special postdischarge formula with high contents of protein, minerals and trace elements as well as an long-chain polyunsaturated fatty acid supply, at least until a postconceptional age of 40 weeks, but possibly until about 52 weeks postconceptional age. Continued growth monitoring is required to adapt feeding choices to the needs of individual infants and to avoid underfeeding or overfeeding.

Management of Breastfeeding During and After the Maternity Hospitalization for Late Preterm Infants

“…[1, 90–92] In the absence of evidencebased guidelines, many clinicians elect to supplement human milk feedings with powdered formulas or to replace some daily breastfeedings with enriched formula “to be on the safe side.” However, there is compelling evidence about the detrimental impact of bovine-based formulas in the early post-birth period with respect to the developing gut microbiota, the upregulation of inflammatory processes and interference with the bioactive components in human milk. [17–26] These practices shorten the lifetime dose of human milk for the recipient infant, increasing the risk of later childhood and adultonset morbidities such as obesity, hypertension, diabetes, inflammatory bowel disease and atopic illness.…”

“…[93] Only a handful of recent studies about post-discharge nutrition with VLBW infants has actually measured milk intake during breastfeeding using test-weighing techniques. [1, 88, 90–92] Thus, if infants fail to grow properly, it is assumed that the quality rather than the quantity of the milk is inadequate. [53, 54, 88] In-home test-weighing procedures using scales designed for the rental market (BabyWeigh®, Medela, Inc., McHenry, IL) measure milk intake to the nearest 2mLs, are accurate, and are easily performed in the home by caregivers.…”

The Effects of Formula Feeding on Physiological and Immunological Parameters in the Gut of Neonatal Rats

“…This model highlights a phenomenon that has been described extensively in rat models and human preterm infants. These infants do not increase in weight compared to their termbirth counterparts [33][34][35]. Indeed, in order to overcome this problem in clinical practice, pre-term infants now receive human milk fortifiers to supplement this deficiency [36].…”

Duração do aleitamento materno em prematuros acompanhados em serviço de referência secundário

“…The use of formula is only indicated when feeding the infant breast milk is impossible1 , 4 and, for a successful breastfeeding after discharge, it is important that the preterm infant receive exclusive breastfeeding at the time of discharge 16. There is evidence that mothers of preterm infants have lower success rates in breastfeeding, and thus the adoption of practices that aim to establish and maintain the supply of breast milk as first choice for feeding preterm infants, considered a vulnerable population, must be continually supported and reviewed 1…”