Premature infant's nutrition - Feeding strategies

Nutrition for preterm babies is aimed at achieving expected intrauterine growth and accretion of nutrients. Early aggressive nutrition in low birth-weight premature infants will prevent malnutrition and catabolic state. Early trophic feedings should be started as soon as possible for gastrointestinal priming. Enteral feedings are gradually increased as intravenous parenteral nutrition is weaned. Mother's (breast) milk is the best food for preterm babies, however it should be nutritionally enriched by powdered human milk fortifier. Preterm babies may also be fed with humanized cow milk based formulas, adjusted for the special needs of prematurity. Sucking skills usually mature around 34 weeks, corrected gestational age. Thus, small preemies are initially fed by orogastric tubes. Continuous gastric drip has no nutritional advantage, and most preemies tolerate bolus feedings well. The recommended daily increase in enteral feedings is up to 20 cc/kg/day, in order to achieve full enteral feedings fast enough, while trying to minimize the risk of necrotizing enterocolitis. As preterm babies mature, nutritive sucking is gradually introduced. Nutritive sucking is a complex action requiring coordination of sucking, swallowing and breathing. Nutritional assessment of preterm babies and nutritional recommendations upon discharge from the hospital are discussed.