Nutritional requirements of premature INFANT

REGARDING NUTRITIONAL REQUIREMENT OF PREMATURE BORN

1. NUTRITION FEEDING PREMATURE INFANT BY: MANISHA SHARMA NURSING TUTOR

2. Introduction Preterm is defined as  babies born alive before 37 weeks of pregnancy are completed . There are sub-categories of preterm birth, based on gestational age: extremely preterm (less than 28 weeks) very preterm (28 to 32 weeks) moderate to late preterm (32 to 37 weeks ).

3. Key points Premature babies may be fed intravenously, through a feeding tube or directly by mouth. How and what a premature baby is fed depends on their gestational age and complications with any part of their GI tract.

4. Objectives Meeting the recognised nutritional requirements of the preterm infant. Achieving an acceptable standard of short term growth. Preventing feeding-related morbidities, especially necrotising enterocolitis (NEC). Optimising long-term outcomes

5. Indications Evidence supports early enteral feeding.  Stable infants of any gestation, with no contraindications, should commence enteral feeding as close to birth as possible (7).  If feeding contraindicated/feeding intolerance, colostrum should be used buccally as mouth care (see below). Regular assessment should be undertaken for evidence of any feed intolerance, particularly “high risk”:

6. Nutritional requirements Nutrient Term infant Preterm infant Tsang 2005 Preterm infant 1-1.8kg ESPGHAN 2010 ELBW (<1kg) VLBW (1-1.5kg) Energy (Kcal/kg) 95 -115 130-150 110-130 110 -135 Protein (g/kg) 2 3.8-4.4 3.4-4.2 4.0 – 4.5 (<1kg) 3.5 – 4.0 (1-1.8kg) Sodium (mmol/kg)  * 1.5 3.0-5.0 3.0-5.0 3.0 – 5.0 Potassium (mmol/kg) 3.4 2.0-3.0 2.0-3.0 2.0 – 3.5 Calcium (mmol/Kg) 3.8 2.5-5.5 2.5-5.5 3.0 – 3.5 Phosphate (mmol/kg) 2.1 2.0-4.5 2.0-4.5 1.9 – 2.9

7. Types of feeding There are three ways to feed premature babies: intravenously, through a feeding tube, and directly by mouth. They may receive three different kinds of nutrition: total parenteral nutrition (TPN), breast milk, and infant formula designed for premature babies. How and what a premature baby is fed depends on their gestational age and whether there are complications with any part of the gastrointestinal tract.

8. Intravenous feeding and parenteral nutrition Although even the most premature gut is capable of accepting and digesting milk, sometimes the baby may be too unwell to be fed this way. In such cases, premature babies are fed in a way that bypasses the digestive system altogether and delivers nutrition directly to the baby’s bloodstream through an intravenous line (IV) or a catheter.

9. Through this line, a premature baby is initially fed sugar water with essential electrolytes for a few days, followed by a solution called total parenteral nutrition (TPN). Made up of proteins, vitamins, minerals, sugar, fat and water, TPN feeding may go on for days or weeks depending on the maturity of the baby and their ability to feed in an alternative way.

10. When to stop TPN and remove intravenous/Central lines For babies born before 28+0 weeks, consider stopping parenteral nutrition within 24 hours once the enteral feed volume is 140 to 150 ml/kg/day. For preterm babies born at or after 28+0 weeks, consider stopping parenteral nutrition within 24 hours if the enteral feed volume tolerated is 120 to 140 ml/kg/day. Locally we have agreed that, to minimise infection risk, removal of lines may be considered once an infant is making good progress with feed advancements and has reached an intake of at least 120ml/kg/day of feeds .

11. Gavage feeding Once the premature baby is stable enough to receive feeding through the gut, they can be given gavage or nasogastric (NG) feedings. A small tube is inserted through the nose or mouth and run directly into the baby’s stomach. Small amounts of expressed breast milk or formula are then gently allowed to flow into the stomach. If the baby handles these feedings, they are fed progressively larger quantities.

12. Breastfeeding and bottle feeding Once the baby has developed the co-ordination to begin sucking and swallowing, the team will make an effort to help the parents with breast feeding. Most mothers are encouraged to pump their milk right away so that the flow of milk begins and continues. Pumped breast milk can be given to the baby when they are ready for either gavage , breastfeeding or bottle feeding. Many parents have a great desire to feed their child themselves, which enhances their parenting role and helps with the bonding process.