Initial Feeding method
All stable preemies should be nestled by their mother's breasts. The immature suckling rapidly matures into proper suckling and improves milk secretion from the nursing mothers.
In preemies <28 weeks, with deficiency in sucking efforts and gut functions, intravenous fluids are preferred. As the maturity develops (28-31 weeks), the preemies are fed via orogastric tube as the infants have interrupted suck-swallow-breathe coordination. As the coordination between breathing and swallowing becomes better, by 32-34 weeks, the preemies can be fed by spoon or cup. Ultimately, the Preemies >34 weeks, are graduated to be breastfed at the mother's breast.1,3
Choice of Feed
Expressed breast milk:
Breast milk is the ideal nutritional choice for all preemies. It can be delivered while breast feeding or can be expressed to be fed by spoon or cup.
Breast milk is safe, always at the right temperature, and offers a guaranteed reliable source of affordable and nutritious food for the babies. Expressed breast milk can be stored for about 6 hours at ambient room temperature and for 24 hours in refrigerator.
It provides almost all the recommended dietary proteins, sugars, and fats needed for the health of the baby. It also contains many products that improve the infant's immune system, including antibodies, immune factors, enzymes, and white blood cells. This affords potent protection against diverse diseases and infections. Consumption of breast milk by the baby fosters necessary commensal growth in the intestines and substantially decreases the chances of illnesses like diarrhea, pneumonia, or necrotizing enterocolitis, etc.
Breast milk feeding thus, offers multiples healthy advantages, and reciprocated improvement in the growth and development of preemies.1,3,4
Donor Human milk:
Nowadays, certain centers have the option of milk banking facilities. Donor human milk can be fed to preemies in circumstances where the mother's milk is not available.1,3
Preemies can be fed by formula feeds containing the right amount of nutrition for them. Either the infants can be supplemented with individual nutrients, e.g., calcium, phosphorus, vitamins, etc.; or by fortification of expressed breast milk with human milk fortifiers (HMF) or with a commercially available preemies formula. Nevertheless, these preemies should be started on exclusive breastfeed once mother's condition stabilizes and breast milk becomes available.1,3
How much is enough
The daily fluid requirement depends on the estimated insensible water loss, other losses, and urine output. Due to deficient skin integrity and the associated high insensible water loss, preemies need more fluids for proper replenishment.
Intravenous fluids are generally started at 80 mL and 60 mL/kg/day for infant’s birth weights of <1500g and 1500-2500g respectively. The usual daily increment would be around 15-20 mL/kg/day so that the infants receive about 150 mL/kg/day by the first week.
The gavage (orogastric) feed volume would be estimated after estimating the fluid requirement of the Preemies. Usually, around 10-15 mL/kg/day is recommended in a 3-6 hourly feeding schedule. As the baby becomes clinically stable, the feeds can be advanced at the rate of 20-30 mL/kg/day. However, the infant should be constantly monitored for any feed intolerance including gastric residuals or clinical signs of necrotizing enterocolitis.5,6,7
Way to go...
To reach the goals of weight gain for preemies, adequate nutrition is needed. Minimal oral feeding should commence right from day one, if possible, and feeding advancement should be conducted based on the clinical course of each preemies. During, hospitalization, oral feeding with Preemies formula and breast milk are the best practices to improve growth. After discharge, this should be individualized as per the nutritional requirements of the infant and modified continuously to achieve the target growth parameters.
- WHO. Edmund K and Bahl R.(2006). Optimal feeding of low-birth-weight infants: Technical Review. [As accessed on 18.10.17]
- Dodrill P. (Dec 2011). Feeding Difficulties in Preterm Infants. ICAN: Infant, Child, & Adolescent Nutrition, 3(6), pp. 324-331.
- Sankar M.J., Agarwal R., Mishra S., Deorari A.K. and Paul V.K. (May 2008). Symposium on AIIMS Protocols in Neonatology - V: Feeding of Low Birth Weight Infants. Indian Journal of Pediatrics, 75, pp. 459-469.
- Aggarwal R., Deorari A. and Paul V.K. AIIMS Protocols in Neonatology: Fluid and electrolyte management in term and preterm neonates. Available from: http://www.newbornwhocc.org/pdf/fluid_electrolytes_bablance.pdf. [As assessed on 18.10.17]
- Steward D.K. (2012). Growth outcomes of Preterm Infants in the Neonatal Intensive Care Unit. Newborn & Infant Nursing Reviews, 12(4), pp.214-220.
- American Academy of Pediatrics. Eidelman A.I. and Schanler R.J. (Mar 2012). Policy Statement: Breastfeeding and the Use of Human Milk. Pediatrics. 129(3), pp.e827-e841.
- AIIMS-NICU Protocols (2007). Minimal Enteral Nutrition. Available from: http://www.newbornwhocc.org/pdf/minimal_ernteral_nutrition.pdf. [As assessed on 18.10.17]