Premature Infants

    Premature infants have unique post-discharge needs

    As premature birth rates continue to rise, the challenges parents face when bringing their baby home are also increasing

    The premature birth rate has consistently risen every year over the last five years1. In addition to the emotional and financial concerns premature birth places on families, premature infants may experience some difficulties like breathing and feeding issues, as well as developmental delays1. These issues can lead to increased use of primary care and special services throughout the first year, and may even lead to hospital readmission2.

    Hospital readmission for premature infants

    Studies have found that infants in the NICU may be more likely to be rehospitalized during their first two weeks2. Common reasons for rehospitalization after discharge include jaundice3 as well as respiratory and feeding issues2.

    Ensuring that parents are ready to transition their baby from hospital to home is important, as the first two weeks after NICU discharge is the time an infant is most likely to be readmitted to the hospital2.

    Learn more about this critical transition period:

    Read Article

    Defining prematurity

    Using the term “premature infant” often doesn’t tell the whole story. How prematurely an infant was born, as well as the infant’s weight at birth, can be helpful for understanding the potential challenges that may lie ahead.

    For example, extremely preterm and low birth weight infants are more likely to experience adverse neurodevelopmental outcomes4, whereas common morbidities in late and moderately preterm infants are respiratory and feeding issues5.

    Distinguishing between the stages of prematurity can be helpful for setting expectations with parents and caregivers.

    Stages of Prematurity5
    Extremely preterm <28 weeks
    Very preterm 28 weeks to <32 weeks
    Moderately preterm 32 weeks to <34 weeks
    Late preterm 34 weeks to <37 weeks
    Birth Weight
    Low birth weight <2500 g (5.5 pounds)
    Very low birth weight <1500 g (3.3 pounds)
    Extremely low birth weight <1000 g (2.2 pounds)

    Unique nutrition needs of premature infants

    Because premature infants miss critical intrauterine growth in the third trimester, they have different nutritional needs than term infants. They are likely born with insufficient stores of nutrients like iron, calcium, phosphorus and vitamin D5. The third trimester is also when the baby would normally be getting the highest amounts of intrauterine DHA6, which is why offering expert-recommended amounts is important for the cognitive and developmental growth of premature infants. Ensuring adequate protein intake is important because it impacts linear growth, which is related to neurodevelopmental outcomes4.

    Late and moderately preterm infants are the largest population of premature infants5. Learn more about their unique nutritional needs in this position paper from ESPGHAN:

    Read Position Paper

    Nutrition planning and feeding management

    Helping reduce the risk of necrotizing enterocolitis (NEC)

    NEC is a major concern with premature infants, due to their underdeveloped gastrointestinal and immune systems7. In developed countries, it is estimated that between 5% and 12% of very low birth weight infants develop NEC; birth at <32 weeks, birth weight of <1500 g (3.3 pounds) and cardiac complications increase the risk of NEC7.

    The use of human milk appears to help avoid incidence of NEC in premature infants8. Human milk alone may not always have the appropriate amounts of nutrients for premature infants, and human milk fortifiers should be used9. While it has been suggested that cow’s milk-based feeding may increase the likelihood of NEC, experts have agreed that there is no indication that using bovine human milk fortifiers will result in adverse effects in premature infants9.

    Human milk feeding

    Feeding human milk to premature infants is the recommended feeding strategy. Not only does human milk offer important immune benefits, but it also helps avoid incidence of sepsis and NEC9. Additionally, human milk is associated with lower incidence in other conditions of prematurity, including retinopathy and bronchopulmonary dysplasia11.

    In a prospective study of over 3,000 pregnant women, more than 90% indicated that they planned to breastfeed, but about a third of the women who gave birth to late preterm infants had discontinued breastfeeding by 1 month postpartum10. Even though feeding human milk is the preferred choice for these infants, feeding issues due to underdevelopment can make breastfeeding challenging, as well as low production of breast milk in some mothers who have premature infants10.

    Read the full study here:

    Read Study

    Post-discharge formulas

    Post-discharge formulas are designed with premature infants’ unique nutritional needs in mind. To help support weight and growth in premature infants, these formulas include increased caloric density, protein, and some vitamins and minerals compared to standard term formulas.

    DHA for continued development

    Choosing a formula with expert-recommended DHA is important for premature infants

    The third trimester is a time of rapid brain growth13 and DHA accumulation in the brain6. Because their abrupt birth interrupts the third trimester, DHA can be especially important for the cognitive and developmental growth of premature infants.

    The minimum expert recommendation for DHA for premature and very low birth weight infants is 16.4 mg/100 kcal14. However, only 2 out of 10 premature infants consume the recommended amount post-discharge15.

     

    DHA has an impact on growth and cognitive development. Premature infants who consume formula with DHA at 0.32% of total fatty acids have been shown* to have16:

    • Improved length

    • Improved weight

    • Higher mental scores

    • Higher psychomotor scores

    * When used in a program of Enfamil® formulas: Enfamil® Premature, Enfamil® EnfaCare® and Enfamil® Infant. Improvement shown through 18 months corrected age. Studied before the reformulation of EnfaCare.

    Provide parents with a post-discharge formula designed especially for premature infants:

    See Post-Discharge Formula

    References

    1. Centers for Disease Control and Prevention. Preterm Birth. https://www.cdc.gov/reproductivehealth/maternalinfanthealth/pretermbirth.htm. Published October 30, 2020. Accessed November 11, 2020.
    2. Boykova M, Kenner C. Transition from Hospital to Home for Parents of Preterm Infants. J Perinat Neonatal Nurs. 2012;26(1):81-87.
    3. Escobar GJ, Hulac P, Kincannon E, et al. Rehospitalisation After Birth Hospitalisation: Patterns Among Infants of All Gestations. Arch Dis Child. 2005;90:125-131.
    4. Cormack BE, Harding JE, Miller SP, Bloomfield FH. The Influence of Early Nutrition on Brain Growth and Neurodevelopment in Extremely Preterm Babies: A Narrative Review. Nutrients. 2019;11:2029. doi:10.3390/nu11092029
    5. Lapillonne A, Bronsky J, Campoy C, et al. Feeding the Late and Moderately Preterm Infant: A Position Paper of the European Society for Paediatric Gastroenterology, Hepatology and Nutrition Committee on Nutrition. J Pediatr Gastroenterol Nutr. 2019;69:259-270.
    6. Martinez M. Tissue Levels of Polyunsaturated Fatty Acids During Early Human Development. J Pediatr. 1992;120(suppl):S129-S138.
    7. Shulhan J, Dicken B, Hartling L, Larsen BMK. Current Knowledge of Necrotizing Enterocolitis in Preterm Infants and the Impact of Different Types of Enteral Nutrition Products. Adv Nutr. 2017;8(1):80-91.
    8. Neu J. In: Koletzko B, Poindexter B, Uauy R (eds). Nutritional Care of Preterm Infants: Scientific Basis and Practical Guidelines. Basel, Switzerland. Karger. 2014;110:261.
    9. Ziegler EE. In: Koletzko B, Poindexter B, Uauy R (eds). Nutritional Care of Preterm Infants: Scientific Basis and Practical Guidelines. Basel, Switzerland. Karger. 2014;110:223,225.
    10. Hackman NM, Alligood-Percoco N, Martin A, et al. Reduced Breastfeeding Rates in Firstborn Late Preterm and Early Term Infants. Breastfeed Med. 2016;11(3):119-125.
    11. Hair AB, Peluso AM, Hawthorne KM, et al. Beyond Necrotizing Enterocolitis Prevention: Improving Outcomes with an Exclusive Human Milk-Based Diet. Breastfeeding Med. 2016;11(2):70-74.
    12. American Academy of Pediatrics Committee on Nutrition. Feeding the Infant. In: Kleinman RE, Greer FR (eds). Pediatric Nutrition. 8th ed. Itasca, Illinois: American Academy of Pediatrics. 2019:151-152.
    13. Dobbing J, Sands J. Quantitative Growth and Development of Human Brain. Arch Dis Child. 1973;48(10):757-767.
    14. Koletzko B, Poindexter B, Uauy R (eds). Nutritional Care of Preterm Infants: Scientific Basis and Practical Guidelines. World Rev Nutr Diet. Basel, Switzerland. Karger. 2014;110:298,300.
    15. Data on file, Mead Johnson Nutrition.
    16. Clandinin MT, Van Aerde JE, Merkel KL, et al. Growth and Development of Preterm Infants Fed Infant Formulas Containing Docosahexaenoic Acid and Arachidonic Acid. J Pediatr. 2005;146:461-468.