Unit 3: Nutrition and Feeding Practice in Preterm Infants

A recommended strategy is to weigh the infant daily and measure length and head circumference weekly. Growth velocity should also be calculated weekly in order to identify growth faltering and for nutrition support review. The commonly used target for weight gain velocity of 15 g/kg/day may be too low (Poindexter 2014).  It seems that such weight gain underestimates the growth that is necessary to reach optimal growth and beneficial outcomes. 

Ideally, the infant's parents should be present when growth is assessed, as they are particularly important members of the care team and take on responsibility for feeding and some monitoring of growth after hospital discharge.

If growth failure is suspected or identified despite efforts to prevent it through optimal provision of nutrients, is it useful to analyze possible causes systematically.

First, target intakes should be reviewed to make sure the prescribed intakes are adequate for growth. The target intakes for preterm infants are covered in Unit 2 of this module.

Next, it is important to verify that the infant is actually receiving the intakes prescribed by the care team. Discrepancies can arise between prescribed and actual intakes when feeds are interrupted. Parenteral feeds may be paused for transfusion of blood or blood products, for infusion of medications, or during changes to infusions to compensate for electrolyte imbalances. As enteral feeds are being introduced, the infant is frequently evaluated for feeding intolerance. Sometimes enteral feeds are slowed or held due to concerns of feed intolerance without a compensatory increase PN.

Finally, it is important to recognize that the protein content of human milk given to the infant may be lower than expected despite use of standard human milk fortifiers; higher-protein fortification may be necessary (Poindexter 2014). (See Lesson 2 for a discussion of the protein content of human milk).