Weaning preterm infants: a randomised controlled trial

Abstract

Objective: To assess the effect on growth and iron status in preterm infants of a specially devised weaning strategy compared with current best practices in infant feeding. The preterm weaning strategy recommended the early onset of weaning and the use of foods with a higher energy and protein content than standard milk formula, and foods that are rich sources of iron and zinc. Subjects and design: In a blinded, controlled study, 68 preterm infants (mean (SD) birth weight 1470 (430) g and mean (SD) gestational age 31.3 (2.9) weeks) were randomised to either the preterm weaning strategy group (n = 37) or a current best practice control group (n = 31), from hospital discharge until 1 year gestation corrected age (GCA). Main outcome measures: Weight, supine length, occipitofrontal head circumference, and intakes of energy, protein, and minerals were determined at 0, 6, and 12 months GCA. Levels of haemoglobin, serum iron, and serum ferritin were assayed at 0 and 6 months GCA. Results: Significant positive effects of treatment included: greater increase in standard deviation length scores and length growth velocity; increased intake of energy, protein, and carbohydrate at 6 months GCA and iron at 12 months GCA; increased haemoglobin and serum iron levels at 6 months GCA. Conclusions: The preterm weaning strategy significantly influenced dietary intakes with consequent beneficial effects on growth in length and iron status. This strategy should be adopted as the basis of feeding guidelines for preterm infants after hospital discharge. E vidence is accumulating to support the assertion that low birthweight preterm infants have special nutritional needs in the period after discharge from the neonatal unit. Additional requirements for energy, 1 2 protein, 3 long chain polyunsaturated fatty acids, 4 zinc, 5 iron, 6 calcium, 7 and selenium 8 have all been demonstrated. Furthermore, two randomised controlled trials have shown enhanced growth in preterm infants fed nutrient enriched preterm formula for several months after discharge from neonatal units, compared with those fed standard formula. 10The introduction of solid feeding and the gradual replacement of milk (human or formula) by solid food as the main source of energy and nutrients is a process known as weaning. The onset of weaning occurs almost exclusively after discharge from the neonatal unit. Despite its importance in the nutrition of preterm infants, very little research has been carried out into solid feeding for this population and no randomised controlled trials have been published. Current recommendations on infant weaning fail to take account of differences in nutritional requirements between low birthweight preterm infants and normal birthweight term infants.11 This failure may be responsible, at least in part, for the growth deficit observed throughout childhood in this group of infants. 13Our aim was to develop a safe weaning strategy for preterm infants to optimise growth and neurodevelopment based on the best available evidence, and then to evaluate ...

Beneficial effects of zinc supplementation on head circumference of Nepalese infants and toddlers: a randomized controlled trial

“…28 Three additional studies on the effect of zinc supplementation or the introduction of zinc and iron rich foods in preterm or very low birthweight infants have shown null results. [29][30][31] The literature on randomized studies of zinc supplementation during pregnancy and head circumference at birth is also mixed with two studies reporting an association, 32,33 one showing an association only in children of mothers with body mass index of o26, 34 and four studies suggesting no association. [35][36][37][38] There has been one prospective study based on a food frequency questionnaire suggesting an inverse association between zinc intake of mothers in the second trimester of pregnancy with head circumference at birth.…”

“…[28][29][30][31] Krebs et al 27 randomized 5-month-old infants to complementary feeding groups to receive either pureed beef or iron-fortified cereal. Children in the meat intervention group, with high zinc and protein intake, showed greater increases in head circumference between ages 7 and 12 months.…”

What do babies eat? Evaluation of a food frequency questionnaire to assess the diets of infants aged 12 months

“…The weighed diary A 4 d WD was used to assess the relative validity of the 12-month FFQ, to be consistent with the diary lengths chosen for recent dietary intake studies (11)(12)(13) , and because calculations of inter-individual and intra-individual variation from energy intake data from a previous 7 d WD study for infants aged 12 months (10) showed that 4 d would classify more than 75 % of infants into the correct quintile of intake at this age. All non-human milks, foods and drinks consumed by the infant on each of 4 d were recorded by weight and cooking method.…”

Do mothers understand healthy eating principles for low-birth-weight infants?

“…This is especially true of low-birth-weight (LBW) infants, for whom early nutritional requirements are greater than those of normalweight infants 2 . Randomised clinical trials have shown that these greater nutritional needs may persist beyond the neonatal period 3,4 . However, evidence-based research on the association between early milk and solid feeding in LBW infants and subsequent development and health during childhood and adulthood is limited.…”