Preterm’s Nutrition from Hospital to Solid Foods: Are We Still Navigating by Sight?

Abstract

As preterm birth rates are globally increasing, together with research on preterms’ peculiar needs, neonatologists are still facing the challenge of how to properly feed them. The need to strike a balance between excessive catch-up growth and extrauterine growth retardation, both leading to adverse outcomes, is made even more difficult by the broad range of preterms’ needs. Although mother’s fresh milk is undoubtedly the best nourishment, its availability during hospital stay is often lower than recommended, and its fortification at discharge is still an open issue. Formula milks are available as an alternative to breast milk. However, choosing the right formula requires a thorough evaluation of the infant’s perinatal history and targets. Last but not least, adequate timing and initiation of weaning in premature babies are still a poorly explored matter. This narrative review aims at evaluating the multitude of issues to consider when feeding preterms in the three stages of their first life: in-hospital care, discharge, and, eventually, weaning. Given the current absence of internationally shared guidelines, understanding the potential pitfalls of preterms’ nutrition could help us trace the right path for the right preterm.

Overview of Important Micronutrients Supplementation in Preterm Infants after Discharge: A Call for Consensus

“…There is a consensus on the preterm infants’ nutritional requirements during the hospital stay, with early enteral and parenteral support being the cornerstone of their nutritional management [ 7 , 8 ]. Specifically, breast milk is recommended as the first option for enteral feeding due to its several health benefits [ 9 , 10 ].…”

“…On the contrary, data available on preterm infants’ optimal nutritional management following hospital discharge are limited [ 11 ]. An individualized approach, based on the entity and velocity of catch-up growth, the nutritional requirements and the neurodevelopmental and metabolic issues, has been recommended [ 7 ]. The complementary feeding period has received limited attention within this context, although it exposes preterm infants at further risk of nutritional deficits and excesses, mainly if they have developed postnatal growth retardation and aberrant body composition [ 12 ].…”

“…The complementary feeding period has received limited attention within this context, although it exposes preterm infants at further risk of nutritional deficits and excesses, mainly if they have developed postnatal growth retardation and aberrant body composition [ 12 ]. Despite recommendations for term infants being unable to be applied to preterm infants due to their peculiar nutritional needs and neurodevelopmental trajectories, including feeding difficulties, no universal guidelines for preterm infants’ complementary foods introduction are available [ 7 , 12 , 13 ]. Given the critical role of micronutrients in supporting adequate growth and neurodevelopment [ 14 , 15 ], as listed in Table 1 , attention to their intake should also be paid during complementary food introduction, especially when acceptance of semi-solid food is still incomplete or problematic [ 7 ].…”

“…Despite recommendations for term infants being unable to be applied to preterm infants due to their peculiar nutritional needs and neurodevelopmental trajectories, including feeding difficulties, no universal guidelines for preterm infants’ complementary foods introduction are available [ 7 , 12 , 13 ]. Given the critical role of micronutrients in supporting adequate growth and neurodevelopment [ 14 , 15 ], as listed in Table 1 , attention to their intake should also be paid during complementary food introduction, especially when acceptance of semi-solid food is still incomplete or problematic [ 7 ]. Previous feeding history (exclusively breastfeeding, fortification, use of post-discharge or standard formulas), growth patterns, including the achievement of catch-up growth, and the presence of eating difficulties should also be taken into consideration when planning complementary foods introduction in preterm infants [ 7 ].…”

“…Given the critical role of micronutrients in supporting adequate growth and neurodevelopment [ 14 , 15 ], as listed in Table 1 , attention to their intake should also be paid during complementary food introduction, especially when acceptance of semi-solid food is still incomplete or problematic [ 7 ]. Previous feeding history (exclusively breastfeeding, fortification, use of post-discharge or standard formulas), growth patterns, including the achievement of catch-up growth, and the presence of eating difficulties should also be taken into consideration when planning complementary foods introduction in preterm infants [ 7 ]. Preterm infants are supplemented with iron and multivitamins after discharge, but the length and dose of supplementation widely differ [ 16 ].…”