Nutrition for premature babies and importance of breast milk

Nutrition for premature babies and importance of breast milk

In order to manage a pregnancy well, you need to prepare and plan for emergencies. Premature birth is one of them. A premature baby is usually born before the 37th week of pregnancy begins, and they usually have low birth weight and suffer from medical conditions in many cases. Hence, providing them with the right nutrition is extremely important for proper growth and development. Wondering how to feed your premature infant right? Learn all about the importance of breastfeeding and nutrition for your preterm baby in this article.

Preterm babies

As mentioned above, preterm infants are those who are born within 37 weeks of gestation. Some are born with low birth weight, some with very low birth weight and some with extremely low birth weight. Here is what you should know.

  • Low birth weight infants are the ones whose weight at birth is less than 2000g. Some of them are born early, some of them are born at term but are small for their gestational age, and some are born early and are small for their gestational age too.
  • Very low birth weight infants are the ones whose birth weight is equal to or less than 1500g, and they exhibit very slow weight gain of maybe less than 25g/day. They have poor intake too, i.e., less than 150 ml/kg/day.
  • Extremely low birth weight infants are those who weigh less than 1000g, and they might be at risk of complications like chronic lung disease and retinopathy.

Low birth weight can account for 60 – 80% of neonatal deaths. Preterm birth accounts for about 20% of the total neonatal deaths that occur globally every year. Adequate nutrition for premature babies, thus, is of utmost importance. Breastfeeding can be started only after preterm infants know how to swallow, coordinate, and learn how to properly latch and suckle.

Breast milk and its importance

Premature infants have different nutritional needs than other infants. Adequate nutrition can protect them against growth failure, developmental delays, and other conditions associated with decreased gestational age and birth weight. Mother’s milk also enhances the development of the infant’s brain and decreases the risk of conditions like necrotizing enterocolitis and late onset of sepsis.

Breastfeeding premature infants can lower the rate of metabolic syndrome, blood pressure, LDL levels, insulin, and leptin resistance. This should be the primary source of nourishment for the premature infant. If the mother is not able to provide an adequate supply of milk, then donor's milk can be given after proper processing, along with the mother’s milk, rather than premature infant formula. However, all said and done, the mother’s milk is always superior to the donor’s milk. So, increased efforts need to be made to establish and maintain the mother’s milk supply.

Breast milk is whey-predominant protein that is tolerated by preterm infants. It has low renal solute load and have anti-infective factors that boost your child’s immunity. Early feeding of colostrum and transitional milk can help in enhancing the gut health too.

Premature breastfeeding guidelines state that infants born within 34 weeks of gestation and those who weigh less than 2000g at birth need fortified human milk. Even those who are on total parenteral nutrition for more than four weeks and are at a risk of developing nutritional deficiencies are recommended fortified human milk. Breast milk of mothers who have delivered preterm is fortified with greater quantity of protein and bioactive molecules to boost infant growth. Fortification of breast milk can help in improving weight gain, protein stores, bone mineralization and absorption of calcium, phosphorus, and alkaline phosphatase.

Requirements of preterm infants

Growth in preterm babies usually occurs in the second week of his or her life. The quality of growth is dependent on the type of feeding. A total of about 105 to 130 kcal/kg/day is required by a preterm infant to achieve normal growth and development. Protein intake should be 2.8 to 3.1g/kg of their body weight. Fats are the major source of energy for preterm infants. Almost half of the energy is derived from fats, and because of the fatty acid composition of human milk, the fats in it are better absorbed by the infant. Once the infant has achieved a stable condition, the energy from fats is replaced by carbohydrates, and they need about 10 to 14 g/kg/day.

Nutritional supplements that might be needed other than human milk, are vitamins A, D, K, and minerals like iron, zinc, calcium, and phosphorus. Commercial high calorie preterm infant formulas can be given as recommended by the paediatrician.

Risks for low birth weight infants

Low birth weight infants have lots of feeding and nutritional challenges to overcome. Feeding challenges include difficulty in transitioning from sleep state to awake state, limited endurance, poor suckling and swallowing ability, and poor oral coordination, which can result in poor nutrition and increased mortality risk.

High metabolic need, inadequate nutrient stores, immature physiological system, and other conditions related to prematurity contribute to the additional need for nutrients in preterm infants. There is always a risk of lowered bone density in premature and low birth weight infants, called osteopenia, which might also be accompanied by rickets.

Preterm infants are also at risk of developing iron deficiency or anaemia. Fluid needs are also special for very low birth weight infants suffering from chronic lung, cardiac or renal problems. Insulin resistance or glucose intolerance may be present in very low birth weight infants during childhood, or even in their adult years.

It is necessary to conduct regular bone tests and carry out weight monitoring, as simple weight gain in preterm infants do not confirm the quality of nourishment that they are getting. Do not give them cow’s milk until they reach one year of age at least. Preterm infants need individualized nutritional care and regular medical and nutritional interventions.