Preterm birth is a nutritional emergency; these babies have high nutritional demand. But, despite medical advances in NICU care, it is quite challenging to achieve weight gain in these babies, said a doctor
Preterm babies, more than full-term babies, need a lot of care and attention. Doctors often advise mothers to breastfeed their babies for their complete nutrition up to 6 months of age, with bodies like WHO and UNICEF recommending the same, since breast milk contains all essential nutrients and bioactive factors required for the baby’s growth and development.
When babies are born preterm, breastfeeding alone is not sufficient to meet their nutritional needs, for they are ‘very low birth weight (VLBW)’ babies.
Dr Sreenath Manikanti, senior consultant neonatologist, Kauvery Hospital, Electronic City, Bangalore said preterm babies are born at a period of rapid growth and development of the fetus in the third trimester. “Weight of the fetus is more than triple from the second trimester to the end of the third trimester. When these babies are born early, they are deprived of rapid accumulation of nutrients provided by maternal placenta in the third trimester,” he explained.
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“Preterm birth is a nutritional emergency; these babies have high nutritional demand. But, despite medical advances in NICU care, it is quite challenging to achieve weight gain in these babies. Undernutrition is a critical problem in preterm infants,” the doctor added.
He listed the challenges in ensuring adequate nutrition in preterm babies:
* In preterm babies, the suck and swallow reflex is not established until they reach 34 weeks.
* Preterm babies have an immature gut and trouble digesting milk.
* Lack of MOM (mother’s own milk) in the initial stages.
* Feed intolerance prevents a rapid increase in feed volume.
* Increased risk of NEC (severe gut infection).
What makes up preterm nutrition?
According to Dr Sreenath, these babies can get adequate nutrition if the following strategies are applied:
1. Starting feeds early: Preterm babies need NICU care and are separated from their mothers. Mothers, however, need support and motivation to express breast milk, which can be provided to the babies via nasogastric or orogastric tubes.
2. Total parenteral nutrition: Until full feeds are established, preterm babies need additional nutrition intravenously — glucose, proteins, lipids, electrolytes, calcium and micronutrients. Special preparations of amino acids and lipids are available.
3. Donor mother’s milk: When MOM is not available in initial stages, preterm babies will benefit from human milk banks that provide pasteurised donor human milk (PDHM) by healthy mothers with excess supply.
4. Aggressive enteral nutrition: Carefully advancing feeds and reaching full feeds early, by balancing any feed intolerance.
5. Kangaroo mother care: Skin-to-skin care by mother helps thermoregulation and facilitates weight gain in these babies. Fathers are also encouraged to provide skin care in NICUs.
6. Human milk fortification: Breast milk alone is not sufficient. Hence, human milk fortifiers are added to provide additional protein, calcium and phosphorus to optimise their growth.
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7. Establishing breastfeeding: Establishing direct breastfeeding in NICU as soon as preterm babies develop suck-and-swallow reflexes go a long way in ensuring adequate nutrition. They should be encouraged to have non-nutritive sucking by 30-32 weeks and direct breast feeding by 32-34 weeks of gestation.
8. Vitamin supplements: Preterm babies often need additional supplementation of vitamin D, calcium, phosphorus, multivitamins and iron.
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First published on: 21-11-2022 at 13:20 IST
