Nutritional management of moderate–late preterm infants: Survey of current practice

Abstract

There is variation in the nutritional management of MLPT infants amongst neonatal clinicians, likely due to the lack of evidence from randomised controlled trials on which to base clinical practice. The majority of clinicians are happy providing only dextrose 10% for up to 2-3 days despite this form of nutritional support containing only carbohydrate.

Effects of an Infant Care Education Program for Mothers of Late-preterm Infants on Parenting Confidence, Breastfeeding Rates, and Infants' Growth and Readmission Rates

“…Breast milk is the best source of nutrition for late-preterm infants, but they are often difficult to breastfeed because they frequently become sleepy and display week sucking power [8]. Although it may seem easy to breastfeed late-preterm infants because they appear similar to full-term infants, they have difficulty coordinating the essential components of successful breastfeeding (sucking, breathing, and swallowing) [9]. Therefore, breastfeeding initiation is delayed and the duration of breastfeeding sessions is short [10].…”

“…Accordingly, the present study aimed to develop an infant care education program for mothers of late-preterm infants with a focus on breast milk management including breastfeeding [9], and the prevention and management of problems that frequently occur in late-preterm infants [3][4][5][6]. An additional objective was to examine the intervention program's effects on breastfeeding rate and parenting confidence in mothers, and on growth and readmission rate in infants.…”

The efficacy and safety of peripheral intravenous parenteral nutrition vs 10% glucose in preterm infants born 30 to 33 weeks’ gestation: a randomised controlled trial

“…Caution regarding insertion of central lines in infants who are expected to reach full enteral feeds within ≈5-7 days may explain some of the variation in nutritional management practices. Results from a recent Australian and New Zealand survey [10] and a UK audit [11] in infants born 32-34 weeks' gestation show that < 20% use parenteral nutrition in this population with resulting suboptimal nutrient intakes [11].…”

“…However, central venous lines are not without risk and consequently infants requiring them are cared for in intensive care settings [12,13]. Most moderately preterm newborns [10,11], and in our experience even many less mature infants (30 to 31 weeks' gestation), do not get central venous catheters as they are considered physiologically stable enough to be able to tolerate full enteral nutrition by 5-7 days of age and thus can be cared for in Special Care Units [10,11]. Although recent recommendations state that peripheral venous parenteral nutrition can be given for short periods, the level of evidence for this is low and the risks associated with extravasation high [13,14].…”

“…Although recommendations for early parenteral amino acids and lipid support for very preterm infants (< 32 weeks’ gestation) are clear [ 7 , 8 ], the nutritional requirements of the moderately preterm infant (32 to 33 weeks’ gestation) are less well established [ 9 ]. While practices vary, in many centres moderately preterm infants receive 10% glucose using a peripheral intravenous cannula in the first week of life as enteral feeds are established [ 10 , 11 ]. Parenteral nutrition solutions are typically given via central venous catheters due to their high osmolarity and risks with extravasation if delivered peripherally [ 12 – 15 ].…”