What Is the Main Idea?

Babies born before 37 weeks of gestation require special care and potentially external help in their growth and development. Nutrition, in the form of milk and additional supplements, plays a vital role in weight gain and appropriate overall growth. Lack of proper growth can lead to various health issues. It becomes essential that these premature babies are screened regularly for their growth. Based on the open access research article “The Development and Evaluation of the Nutritional Risk Screening Tool for Preterm Infants from Birth to Corrected Age Four Months Old: A Pilot Study” published in Annals of Nutrition and Metabolism, in this blog post, the parameters that need to be monitored in premature babies and a screening tool to help identify any nutritional issues that can progress to a health risk are described.

What Else Can You Learn?

The reason for monitoring the nutrition in premature infants and the different ways nutrients are fed are explained. Additionally, the kind of nutrition the infant needs is described.

Premature Infants and Why Nutrition Is a Concern

Babies are considered premature when they are born before the 37th week of pregnancy. Some of the issues that a premature infant can have include difficulty breathing since the lungs are not fully developed, maintaining body temperature, slow weight gain, and difficulties with feeding. Long-term issues for those born prematurely can be developmental delays, issues related to neurology as well as cardiovascular, metabolic, or bone health of the person.

For healthy growth, proper nutrition becomes vital in premature babies. Apart from physical growth, being premature affects their metabolism and immune function. It can also lead to problems related to psychomotor and mental skills. Additionally, premature babies are susceptible to nutrition-related problems like malnutrition in protein and energy and iron deficiency.

Things to Know regarding Providing Nutrition for Premature Infants

The main goal regarding nutrition for premature infants is to achieve growth similar to what the baby would have if it was still in the uterus. However, depending on the level of prematurity, feeding the infant can be associated with different issues. Based on how early the infant was born, the infant might have feeding issues because of breathing troubles, oxygen levels, and circulation problems.

There are 2 modes of providing nutrition called enteral and parenteral. With enteral feeding, the food passes through the digestive tract through a tube that starts from the nose or the mouth. In parenteral feeding, the nutrients are given directly into the blood through intravenous (IV) therapy. The main issue with food going through the digestive tract in premature babies is that they can develop a condition called necrotizing enterocolitis (NEC). This condition causes inflammation of the tract and consequently, cells in the tract start dying. In most cases, this issue is addressable. For example, feeding breast milk and slowing the rate of feeding are supposed to help avoid this condition.

Without enteral feeding, if IV therapy alone is used for feeding, it can affect the gut development as the gut will not be active and hence will not produce the required hormones or enable gut mobility.

So, what kind of nutrition is best for the infant? The expressed mother’s milk is considered ideal followed by pasteurized donor’s milk. However, there are some nutrients for growth that are not present sufficiently in mother’s milk to enable the premature infant to grow at the right rate. Therefore, the mother’s milk needs to be supplemented through fortification. The milk can be fortified with extra protein, energy, minerals, and vitamins.

Babies that are born closer to full term could potentially feed directly from the breast or from a bottle. In the case where the infant struggles to form a proper suction at the breast and is not able to control the feed from a bottle, the infant can be given milk through the tube.

Parameters that Help Monitor the Growth of a Premature Infant

To be able to assess whether the premature infant is getting enough nutrition and growing steadily, there are various parameters that can be monitored. While weight gain is of primary importance, the measurements of the body length from crown to heel, head circumference, mid-upper arm circumference, and weight to body length value are measurements that are equally important. These measurements are termed anthropometric measurements. These values will help give a better understanding of how the body composition is changing.

Biochemical markers that indicate the amount of iron, proteins, metabolic and electrolyte composition, and bone status also provide useful information about the growth of premature babies.

To assess if the baby’s growth is progressing well, all these measurements have to be analyzed in conjunction with each other by an expert.

Latest Research on Developing a Nutritional Risk Screening Tool for Premature Infants

As described in the beginning, premature babies have the risk of developing health issues from early on till adulthood. To identify issues early and to provide the appropriate intervention, it becomes vital to be screening the newborns for any risk. However, while there are screening tools that have been developed, there are no standardized methods to do the test yet.

In a recently published article mentioned above, the authors developed a new screening tool to assess for any issues in babies from the time of birth till 4 months corrected age (the age from the time of birth minus the number of weeks or months the infant was born prematurely). The newborns’ medical history, the feeding practices like milk intake, formula use or any fortification, nutrition supplements like vitamin D, and anthropometric measurements were monitored. Through their work, the authors were able to make correlations and predict factors like growth retardation and intellectual development issues to a large extent. However, their models could not predict microencephaly to a similar extent. The research needs more work in developing the predictor model better.

Take-Home Message regarding Premature Nutrition

Parents of premature infants should ensure that the infant is receiving the right nutrition and supplements and in appropriate quantities. One way of ensuring this is by talking to the doctor and doing a nutritional risk assessment. Early intervention can make a big difference in an infant’s development all the way to adulthood.

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