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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.
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:
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 issue5.
Distinguishing between the stages of prematurity can be helpful for setting expectations with parents and caregivers.
| Stages of Prematurity5 | |
|---|---|
| Extremely preterm | 34 weeks and 0 days |
| Very preterm | 36 weeks and 6 days of gestation |
| Moderately preterm | 32 weeks to <34 weeks |
| Late preterm | 28 weeks to <32 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) |
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:
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.
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:
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.
*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.
