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PRETERM INFANTS
- Why?
- What?
- How?
Will my baby
survive?
HOW WILL IT SURVIVE?
Interpretation:
Appropriate weight gain is important for brain development.
Enteral nutrition
• Needs to start in very preterm infants on day of birth
• Preferably fresh own mother’s milk otherwise banked own
mother’s milk
• Aim to achieve full enteral feeding within 7-14 days in
extremely preterm & very preterm infants respectively
ESPGHAN J Pediatr Gastroenterol Nutr 2010;50:85-91 / Ziegler.J Pediatr Gastroenterol Nutr 2015.
WHAT ARE THE KEY FACTORS TO ACHIEVE
THIS GOAL?
• Japan preterm infants GA < 32 wks 57% (Sakurai Pediatr Int 2008)
WHAT ARE THE KEY FACTORS TO ACHIEVE
THIS GOAL?
Enteral nutrition
• Possibility for cohospitalisation of the mother, donor human
milk banks and lactation support improve use of human milk
and time to full enteral feeding (de Waard 2018)
• Human milk fortification is important to support growth (Brown
2016, Arslanoglu 2019)
META-ANALYSIS ON HMF FOR
PRETERM INFANTS
Quality of
Anticipated effects of HMF (95%CI) Nb of infants (studies)
evidence
Conclusions:
Although available trial data show that multi-nutrient fortification increases growth rates of preterm
infants during their initial hospital admission, they do not provide consistent evidence on effects on
longer-term growth or development.
Additional trials are needed to resolve this issue.
Brown, Cochrane Database of Systematic Reviews 2016
CLASSICAL POWDER HMF (+1G PROTEIN/100 ML)
OFTEN DOES NOT MEET ELBW INFANTS NEEDS
Required Required Human milk* Fortified HM§
per kg/d per 100 kcal per 100 kcal per 100 kcal
Energy, kcal 108
Protein, g 4.0 3.8 1.8 2.75
Ca, mg 184 170 37 156
P, mg 126 116 21 94
Mg, mg 6.9 6.4 4.8 6.6
Na, mmol 3.3 3.0 1.8 2.4
K, mmol 2.4 2.2 1.9 2.6
Cl, mmol 2.8 2.6 2.4 2.9
Fe, mg 2.0 1.85 0.13 1.9
Zn, mg 1.5 1.4 0.54 1.5
Cu, mg 120 111 56 102
* 4 weeks after delivery; § classical powder HMF adding 1.0 g of protein per 100 ml of milk Ziegler, WRND 2014
• If own mother’s milk & donor human milk are not avaible a
specific preterm formula should be used
Thank you for your attention! !
Any questions? !
© Oliver Wyman