Feeding The Premature Infant
Controlling the feeding of the premature child is very important to be able to grow at a rate close to that of the babies that are still in the womb.
What is considered a premature child?
Premature is defined as the newborn less than 37 weeks of gestation, counting from the first day after the date of the mother’s last menstruation.
Although there is unanimity in the definition of the premature newborn, there is controversy to define the subgroups of prematurity. The subgroup terminology used is:
- Extreme premature: <28 weeks.
- Very premature: 28 to <32 weeks.
- Moderate premature: 32 to <34 weeks.
- Late preterm : 34 to 37 weeks.
Feeding in the premature
The Nutrition Committee of the American Academy of Pediatrics defines the ideal feeding of the premature infant as one that achieves growth to intrauterine levels without subjecting its immature metabolic and excretory functions to stress.
Babies born before 34 to 37 weeks often have difficulty feeding from a bottle or breast because they have trouble coordinating sucking, breathing, and swallowing.
For this reason, very young infants may need to get their food and fluids through an IV. As they get stronger, they may begin to receive breast milk or formula through a tube.
The tube is inserted into the stomach through the nose or mouth. This is called enteral nasogastric tube feeding. The amount of milk increases very slowly, especially for very premature babies. This reduces the risk of contracting an intestinal infection called necrotizing enterocolitis, according to an article published in the journal “Cirujía y Cirujanos”.
When it comes to reducing the risk of premature infants suffering from this type of intestinal disease, the introduction of probiotics in milk formulas can be considered, as pointed out by a study published in 2019. In addition, this class of microorganisms can help strengthen the immune system of premature babies, which is usually weakened.
Breast milk
Breast milk is the food best tolerated by the premature infant, with a faster gastric emptying and less retention than when it is fed with artificial formulas. Possibly, the low osmolarity of human milk, its species specificity, and its defensive qualities make it possible for it to protect premature infants against necrotizing enterocolitis.
In addition, breastfed premature infants who are subjected to the Kangaroo Mother Method suffer fewer nosocomial infections. They are children who remain in skin-to-skin contact with their mother as soon, continuously and for a long time as possible.
The mother secretes specific immunoglobulins A against the germs on her skin and against the germs in the neonatal area that she has been incorporating and which are responsible for nosocomial infections.
The composition of breast milk varies depending on whether it is mother’s milk from a full-term child or a mother’s milk from a premature child. During the first 24 weeks, mothers of preterm infants secrete milk whose composition is adapted to the estimated nutrient requirements of their children. Only its content in calcium (Ca) and phosphorus (P) is lower.
It is recommended to supplement this milk from week 4 – 6, which is when it becomes ‘mature’, with preparations that contain proteins and minerals. Others supplement calcium and phosphorus to minimize low bone density and biochemical rickets found in the first weeks of life in preterm infants fed their own mother’s milk.
The milk of the premature mother contains a series of amino acids that are necessary for the development of the baby’s central nervous system. In addition, it contains a series of substances that have made it classify the mother’s breast as an immune organ.
It also contains medium and long chain fatty acids that have been linked to higher IQ. It has more cholesterol than ‘mature’ milk and much more than artificial formulas.
Feeding is different in premature infants
It is essential in premature babies to control water requirements. These children have a harder time maintaining the proper balance of water in the body and can become dehydrated or overhydrated.
Some babies will need to continue taking nutritional supplements after leaving the hospital. For nursing babies, this may mean one or two bottles of fortified breast milk per day, as well as iron and vitamin D supplements.
Some babies will need more supplements than others. This includes babies who are unable to consume insufficient milk to obtain the calories they need to grow properly.
