Weaning and complementary feeding in preterm infants: management, timing and health outcome

Abstract

The introduction of solid food is necessary for any infant in order to provide adequate nutrition because when they grow up milk is insufficient for their nutritional needs. Infants born preterm have increased nutritional requirements. The high nutrient demands as well as the organ immaturity of preterm infants combine to render it difficult to achieve dietary intakes that will allow preterm infants to match their in utero growth rates. Current guidelines for the introduction of solid food to term infants cannot be directly translated to preterm infants. For preterm infants such guidelines are lacking. Based on the limited available evidence, it could be concluded that a corrected age of 3 months (13 weeks) may be an appropriate age to start introducing solid food for most preterm infants. About celiac disease (CD), gluten may be introduced into the infant’s diet anytime between 4 and 12 completed months of age. In children at high risk for CD, earlier introduction of gluten (4 vs 6 months or 6 vs 12 months) is associated with earlier development of CD autoimmunity (defined as positive serology) and CD, but the cumulative incidence of each in later childhood is similar. Relatively to weaning and allergies, the European Society of Pediatric Allergy and Clinical Immunology and the European Society for Paediatric Gastroenterology Hepatology and Nutrition have produced joint guidelines. They recommend exclusive breastfeeding for 4–6 months or use of hypoallergenic formulas if exclusive breastfeeding is not possible. In addition, The American Academy of Pediatrics recommendations now state that there is no evidence to recommend maternal dietary restrictions during pregnancy or breastfeeding. However, there is no evidence that delaying introduction of solids including allergenic foods after 4–6 months is protective.

Preterm’s Nutrition from Hospital to Solid Foods: Are We Still Navigating by Sight?

“…However, although evidence-based recommendations on LBW and extremely low birth weight (ELBW) infants in-hospital nutrition exist [6], little is known about the optimal nutritional approach after discharge and complementary feeding. Despite increasing evidence demonstrating that guidelines for term infants' weaning are not applicable to the preterm population, to date, no specific recommendation for premature babies is universally accepted [5,7,8]. Differences in the development of motor skills and the digestive system between the preterm and term newborn limit the comparison between these two populations.…”

Complementary Feeding in Preterm Infants: A Systematic Review

“…After examining the full texts of the 40 retrieved papers, 14 were excluded, as 9 did not actually deal with CF and 5 reported data only about term infants, leading to 26 suitable studies [ 5 , 6 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 ]. Five additional papers were identified from the reference lists of included studies [ 33 , 34 , 35 , 36 , 37 ]; 31 studies were then included in the systematic review [ 5 , 6 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 ,…”

“…Among these, there were six narrative reviews [5,14,15,22,27,32], one systematic review [13], two meta-analyses [11,33], one commentary [17], two recommendations [36,37] and one study protocol [31]. Among the remaining 18 trials, there were 14 observational studies [6,9,10,12,[18][19][20][21]24,[28][29][30]34,35], two randomized controlled trials (RCTs) [16,25] and two papers pooling data from different RCTs [23,26].…”

Complementary Feeding in the Preterm Infants: Summary of Available Macronutrient Intakes and Requirements

“…As a consequence of prematurity, these infants generally have limited nutrient reserves since they have not been able to take advantage of the crucial last third trimester of pregnancy, period during which there is transfer and accumulation of nutrients from the mother to the fetus associated with a rapid growth. The high need for nutrients and the organ immaturity of preterm infants contribute to the difficulty of achieving dietary intakes that can allow these infants to have adequate growth [15].…”