Nutritional support for preterm infants at the outpatient stage: how to maintain continuity? A review

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Abstract

Globally, 15 million babies are born prematurely each year. Improvements in intensive care methods and treatment approaches have significantly improved the survival rate of this vulnerable group of patients. Suctioning of these babies does not end when they are discharged from hospital, but continues on an outpatient basis. In modern practice, the term "catch-up growth" is used to mean compensatory acceleration of growth of the organism after a period of stunted growth, particularly as a result of a lack of nutrients. To assess catch-up growth in the outpatient phase, body weight, height and head circumference should be assessed weekly or every 2 weeks during the first 4–6 weeks after discharge and then according to an individual plan until the child reaches the parameters of full-term peers, making adjustments for postconceptual or adjusted age. Different scales can be used to assess the physical development of preterm infants, such as the Fenton scale or the Intergrowth 21st, each of which has advantages and disadvantages. Maintaining breastfeeding of premature babies after discharge from hospital should remain our goal because of the many advantages, but at the same time on purely breastfeeding a premature baby will not receive sufficient protein, energy and fatty acids. This is where the neonatologist and paediatrician alike come in handy with breast milk fortifiers, whose application in practice is much easier than it seems. According to the "Programme for the Optimisation of Infant Feeding in the First Year of Life in the Russian Federation", breast-milk fortification should be carried out tentatively until 40–52 weeks of post-conceptional age (provided the catch-up parameters of 10–25th centile have been reached). If the child is artificially fed, adapted prematurity formula (with a protein content of 2.0 to 2.2 mg/100ml) should be continued until reaching the 10–25th centile, with caloric intake calculated on the basis of 130 kcal/kg with a subsequent reduction. Although premature infants are a very vulnerable group of patients and require a special approach from paediatricians, the seeming difficulties of enteral feeding are quickly resolved if simple algorithms and proven approaches are followed.

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About the authors

Elena S. Pershina

Perinatal Center of the Voronezh Regional Clinical Hospital №1

Author for correspondence.
Email: pershina.elenasergeevna@gmail.com
ORCID iD: 0000-0003-2182-1062

neonatologist, Voronezh Regional Clinical Hospital №1

Russian Federation, Voronezh

Natalya V. Korotaeva

Perinatal Center of the Voronezh Regional Clinical Hospital №1; Burdenko Voronezh State Medical University

Email: pershina.elenasergeevna@gmail.com
ORCID iD: 0000-0001-5859-7717

Cand. Sci. (Med.), Burdenko Voronezh State Medical University, Voronezh Regional Clinical Hospital №1

Russian Federation, Voronezh; Voronezh

Liudmila I. Ippolitova

Burdenko Voronezh State Medical University

Email: pershina.elenasergeevna@gmail.com
ORCID iD: 0000-0001-7076-0484

D. Sci. (Med.), Burdenko Voronezh State Medical University

Russian Federation, Voronezh

References

  1. Adair LS, Fall CH, Osmond C, et al. Associations of linear growth and relative weight gain during early life with adult health and human capital in countries of low and middle income: findings from five birth cohort studies. Lancet. 2013;382(9891):525-34.
  2. Tanner JM. Catch-up growth in man. Br Med Bull. 1981;37(3):233-8.
  3. Prader A, Tanner JM, von Harnack G. Catch-up growth following illness or starvation. An example of developmental canalization in man. J Pediatr. 1963;62:646-59.
  4. Adamkin DH. Enteral nutrition and postdischarge nutrition. Nutrition management of the very low-birthweight infant: II. Optimizing. Neoreviews. 2006;7(12):608-14.
  5. Mangel M, Munch SB. A life-history perspective on short- and long-term consequences of compensatory growth. Am Nat. 2005;166(6):E155-76.
  6. Hack M, Breslau N, Weissman B, et al. Effect of very low birth weight and subnormal head size on cognitive abilities at school age. N Engl J Med. 1991;325(4):231-7. doi: 10.1056/NEJM199107253250403
  7. Рафикова Ю.С., Саприна Т.В., Михалев Е.В., Лошкова Е.В. Особенности пищевого поведения детей и подростков, родившихся недоношенными. Современные проблемы науки и образования. 2015;6 [Rafikova IuS, Saprina TV, Mikhalev EV, Loshkova EV. Osobennosti pishchevogo povedeniia detei i podrostkov, rodivshikhsia nedonoshennymi. Sovremennye problemy nauki i obrazovaniia. 2015;6 (in Russian)].
  8. Ong KK, Kennedy K, Castañeda-Gutiérrez E, et al. Postnatal growth in preterm infants and later health outcomes: a systematic review. Acta Paediatr. 2015;104(10):974-86.
  9. Kerkhof GF, Willemsen RH, Leunissen RW, et al. Health profile of young adults born preterm: negative effects of rapid weight gain in early life. J Clin Endocrinol Metab. 2012;97(12):4498-506.
  10. Fenton TR, Anderson D, Groh-Wargo S, et al. An Attempt to Standardize the Calculation of Growth Velocity of Preterm Infants-Evaluation of Practical Bedside Methods. Pediatr. 2018;196:77-83.
  11. Gomez-Gallego C, Garcia-Mantrana I, Salminen S, Collado MC. The human milk microbiome and factors influencing its composition and activity. Semin Fetal Neonatal Med. 2016;21(6):400.
  12. Ballard O, Morrow AL. Human milk composition: nutrients and bioactive factors. Pediatr Clin North Am. 2013;60(1):49-74.
  13. Promoting human milk and breastfeeding for the very low birth weight infant. Parker mg, stellwagen lm, noble l, kim jh, poindexter bb, puopolo km, section on breastfeeding, committee on nutrition, committee on fetus and newborn. Pediatrics. 2021;148(5):e2021054272.
  14. Patra K, Hamilton M, Johnson TJ, et al. NICU Human Milk Dose and 20-Month Neurodevelopmental Outcome in Very Low Birth Weight Infants. Neonatology. 2017;112(4):330.
  15. Koletzko B, Poindexter B, Uauy R. Nutritional Care of Preterm Infants: Scientific Basis and Practical Guidelines. Karger, 2014.
  16. Koletzko B, Poindexter B, Uauy R. Nutritional Care of Preterm Infants. Scientific Basis and Practical Guidelines. World Review of Nutrition and Dietetics. Vol. 110. Switzerland, 2014.
  17. Abrams SA, Committee on Nutrition. Calcium and vitamin D requirements of enterally fed preterm infants. Pediatrics. 2013; 131:e1676
  18. Abrams SA. Zinc for preterm infants: Who needs it and how much is needed? Am J Clin Nutr. 2013;98(6):1373.
  19. King C, Winter R. PC.129 Use of breast milk fortifier in a preterm baby post discharge to avoid use of formula. Arch Dis Child Fetal Neonatal Ed. 2014;99:A80. doi: 10.1136/archdischild-2014-306576.229
  20. Zachariassen G, Faerk J, Grytter C, et al. Nutrient enrichment of mother’s milk and growth of very preterm infants after hospital discharge. Pediatrics. 2011;127(4):e995-1003. doi: 10.1542/peds.2010-0723
  21. Программа оптимизации вскармливания детей первого года жизни в Российской Федерации: методические рекомендации ФГАУ «НМИЦ здоровья детей» Минздрава России. М., 2019 [Programma optimizatsii vskarmlivaniia detei pervogo goda zhizni v Rossiiskoi Federatsii: metodicheskie rekomendatsii FGAU “NMITs zdorov'ia detei” Minzdrava Rossii. Moscow, 2019 (in Russian)].


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