Unit 3: Nutrition and Feeding Practice in Preterm Infants

The nutritional needs of preterm infants following discharge will to a large extent depend on the degree of nutritional deficits accrued during hospitalization. If optimal nutrition can be provided starting at birth and maintained during the time in the neonatal ward, preterm infants will have fewer deficits and less need for "catch-up” growth when they go home.

Good discharge planning is required to ensure a smooth transition from neonatal care unit to home. Challenges to be surmounted include a transition in most cases to a new healthcare provider and a relatively new feeding regimen (often after a recent advance to full enteral feeds or to longer feeds directly at the breast). Preterm infants who are receiving human milk are at particularly high risk of breastfeeding failure. This is due to the difficulties that many preterm infants experience with coordinating their suck and swallow in order to extract milk effectively from the breast, the lesser strength and stamina of preterm infants relative to term infants, and the challenge for mothers of preterm infants to establish and maintain an adequate milk supply (Lapillonne 2014).

Clear standards and guidelines for feeding and monitoring of preterm infants following discharge from the hospital are lacking. Discharge planning and practices vary greatly worldwide. Moreover, preterm infants are a very heterogeneous group. They differ widely in terms of degree of prematurity, birth weight, discharge weight, degree of pre- and post-natal growth restriction, and morbidities. The infants with the greatest nutritional needs at hospital discharge include those who: were born VLBW or ELBW; are at lower gestational age at time of hospital discharge; are fed all or mostly human milk; are below the 3rd or 5th percentile on growth charts; and have morbidities that increase energy requirements or affect feed volumes, i.e infants with chronic lung disease, infants with uncoordinated suck and swallow and infants with short bowel due to surgery (Lapillonne 2014)

Nutritional status will vary between preterm infants at the time of discharge. Gestational age, postnatal age, in utero growth, nutritional management during hospitalization, associated morbidities and genetic factors are all likely to influence the nutritional status of the preterm infant by discharge time (Lapillonne 2014). Because preterm infants are such a heterogeneous group, no single guideline can address all possible scenarios and any discharge plan must be tailored to an infant's individual needs.

Though more research is needed in many areas of the post-discharge care of preterm infants, it is not easy to design and carry out studies of this group of patients. As a group, preterm infants are extremely heterogeneous, such that results may not be applicable for some subgroups. Ethical issues and the difficulty of blinding parents and providers to certain interventions such as breastfeeding vs. formula feeding further complicate study design (Lapillonne 2014).