Feeding the preterm infant

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Abstract
Introduction Providing appropriate nutrition for growth and development is a cornerstone of the care of preterm infants. Early postnatal nutrition during this critical period of brain growth may have a substantial impact on clinically important outcomes, including long term neurodevelopment. Infants with intrauterine growth restriction lack subcutaneous fat and other nutrient stores Preterm infants, especially those who have been growth restricted in utero, have fewer nutrient reserves at birth than term infants. Additionally, preterm infants are subject to physiological and metabolic stresses that can affect their nutritional needs, such as respiratory distress or infection. An international consensus group has recommended nutritional requirements for preterm infants. These recommendations are based on data from intrauterine growth and nutrient balance studies and assume that the optimal rate of postnatal growth for preterm infants should be similar to that of normal fetuses of the same postconception age. In practice, however, these target levels of nutrient input are not always achieved and this may result in important nutritional deficits. View this table: In this window In a new window Nutritional requirements for preterm infants* Further reading Anderson GC, Moore E, Hepworth J, Bergman N . Early skin-to-skin contact for mothers and their healthy newborn infants. Cochrane Database Syst Rev 2003;(4): CD003519 Ainsworth SB, Clerihew L, McGuire W . Percutaneous central venous catheters versus peripheral cannulae for delivery of parenteral nutrition in neonates. Cochrane Database Syst Rev 2004;(2): CD004219 Kennedy KA, Tyson JE, Chamnanvanakij S . Rapid versus slow rate of advancement of feedings for promoting growth and preventing necrotizing enterocolitis in parenterally fed low-birth-weight infant. Cochrane Database Syst Rev 2003;(4): CD001241 Kennedy KA, Tyson JE, Chamnanvanikij S . Early versus delayed initiation of progressive enteral feedings for parenterally fed low birth weight or preterm infants. Cochrane Database Syst Rev 2003;(4): CD001970 Tyson JE, Kennedy KA . Minimal enteral nutrition for promoting feeding tolerance and preventing morbidity in parenterally fed infants. Cochrane Database Syst Rev 2004;(2): CD000504 Morley R, Lucas A . Randomized diet in the neonatal period and growth performance until 7.5-8 years of age in preterm children. Am J Clin Nutr 2000;71: 822–8 Lucas A, Morley R, Cole TJ . Randomised trial of early diet in preterm babies and later intelligence quotient. BMJ 1998;317: 1481–7 Cooke RJ, Embleton ND . Feeding issues in preterm infants. Arch Dis Child 2000;83: 215–8 McGuire W, Anthony MY . Formula milk versus term human milk for feeding preterm or low birth weight infants. Cochrane Database Syst Rev 2003;(4): CD002972 Footnotes Ginny Henderson is a neonatal nurse in the Neonatal Intensive Care Unit at Ninewells Hospital and Medical School, Dundee. The ABC of preterm birth is edited by William McGuire, senior lecturer in neonatal medicine, Tayside Institute of Child Health, Ninewells Hospital and Medical School, University of Dundee; and Peter W Fowlie, consultant paediatrician, Perth Royal Infirmary and Ninewells Hospital and Medical School, Dundee. The series will be published as a book in spring 2005. Competing interests For WMcG's competing interests see first article in the series. The photographs showing a woman expressing breast milk, skin to skin contact, and cup feeding are courtesy of the Health Promotion Agency for Northern Ireland.