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Optimizing Nutrition and Dietary Pattern in Premature Infants
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Optimizing Nutrition and Dietary Pattern in Premature Infants

A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601). This special issue belongs to the section "Global Health".

Deadline for manuscript submissions: closed (31 May 2022) | Viewed by 26048

Special Issue Editors

Prof. Luís Pereira-da-Silva

E-Mail Website
Guest Editor
1. Centre of Statistics and its Applications, University of Lisbon, 1749-016 Lisbon, Portugal
2. Medicine of Woman, Childhood and Adolescence Teaching and Research Area, NOVA Medical School, Universidade NOVA de Lisboa, 1169-056 Lisbon, Portugal
Interests: anthropometry in pediatric patients; body composition assessment in infants; infant nutrition
Dr. Gustavo Rocha

E-Mail Website
Guest Editor
Department of Neonatology, Centro Hospitalar Universitário de São João, 4200-319 Porto, Portugal
Interests: bronchopulmonary displasia; neonatal ventilation; preterm and term lung diseases; pulmonary hypertension of the newborn
Dr. Susana Pissarra

E-Mail Website
Guest Editor
Department of Neonatology, Centro Hospitalar Universitário São João, 4200-319 Porto, Portugal
Interests: neonatal gastroenterology and nutrition; neonatal infection

Special Issue Information

Dear Colleagues,

Growth faltering attributed to inadequate nutrient intake is common in infants born prematurely, and enhanced postnatal growth is associated with improved neurodevelopment. Soon after birth, parenteral nutrition should be initiated in very preterm infants, using either individualized or standardized parenteral nutrition. Early initiation of adequate energy, amino acid, fat, and mineral intake is needed for a satisfactory nutritional transition from intrauterine to extrauterine life. Concomitantly with parenteral nutrition, early initiation of trophic enteral feeding is recommended, primarily using the mother's own milk. If this becomes insufficient, donor milk should be the second choice, if available. A multicomponent fortifier should be added to human milk by following one of the proposed fortification methods. Preterm formula is indicated when human milk is insufficient. Bolus feeding is more physiological, but continuous feeding may be necessary when infants do not tolerate intermittent feeding. The criteria to define feeding intolerance are not established, and feeding practices differ among neonatal units in the presence of factors predisposing to necrotizing enterocolitis. The standardization of feeding practices is known to improve growth and nutritional status. After discharge, preterm infants should ideally continue breastfeeding; if growth becomes suboptimal, then fortified breast milk or post-discharge formulas may be needed as complements.

Prof. Dr. Luis Pereira-da-Silva
Dr. Gustavo Rocha
Dr. Susana Pisarra
Guest Editors

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Keywords

  • enteral feeding
  • human milk
  • human milk fortifier
  • parenteral nutrition
  • preterm formula
  • preterm infant
  • throphic feeding

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Published Papers (5 papers)

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Research

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12 pages, 345 KiB  
Article
(Non)Marketing of Breastmilk Substitutes in South African Parenting Magazines: How Marketing Regulations May Be Working
by Sara Jewett, Sukoluhle Pilime and Linda Richter
Int. J. Environ. Res. Public Health 2022, 19(10), 6050; https://doi.org/10.3390/ijerph19106050 - 16 May 2022
Cited by 3 | Viewed by 1989
Abstract
Although exclusive breastfeeding (EBF) for the first six months is optimal for child health, it remains low globally. Breastmilk substitutes (BMS) marketing undermines breastfeeding. In 2012, South Africa introduced Regulation 991, which prohibits marketing BMS products for infants below 6 months. Our study [...] Read more.
Although exclusive breastfeeding (EBF) for the first six months is optimal for child health, it remains low globally. Breastmilk substitutes (BMS) marketing undermines breastfeeding. In 2012, South Africa introduced Regulation 991, which prohibits marketing BMS products for infants below 6 months. Our study aimed to explore if and how BMS products were presented in South African parenting magazines post-R991. We applied a mixed-methods cross-sectional content analysis design, analyzing all 2018 issues of two popular parenting magazines. We descriptively analyzed quantitative codes, derived from an a priori framework, and conducted qualitative content analysis on a subset of texts and images. We found there was no overt marketing of BMS to parents with infants below 6 months. However, BMS advertisements were placed next to articles about young infants, and vague wording and images were ways by which BMS companies may indirectly benefit. Medical experts in both magazines promoted the introduction of solids before six months. To conclude, while BMS companies in South Africa were abiding by R991 by not overtly advertising BMS in parental print media, their influence persists. Continued monitoring of print media as well as other channels is advisable. This study may be of interest to countries considering stronger regulations of BMS advertising. Full article
(This article belongs to the Special Issue Optimizing Nutrition and Dietary Pattern in Premature Infants)
9 pages, 3861 KiB  
Article
Mother’s Own Milk Feeding in Preterm Newborns Admitted to the Neonatal Intensive Care Unit or Special-Care Nursery: Obstacles, Interventions, Risk Calculation
by Nadja Heller, Mario Rüdiger, Vanessa Hoffmeister and Lars Mense
Int. J. Environ. Res. Public Health 2021, 18(8), 4140; https://doi.org/10.3390/ijerph18084140 - 14 Apr 2021
Cited by 15 | Viewed by 4344
Abstract
Early nutrition of newborns significantly influences their long-term health. Mother’s own milk (MOM) feeding lowers the incidence of complications in preterm infants and improves long-term health. Unfortunately, prematurity raises barriers for the initiation of MOM feeding and its continuation. Mother and child are [...] Read more.
Early nutrition of newborns significantly influences their long-term health. Mother’s own milk (MOM) feeding lowers the incidence of complications in preterm infants and improves long-term health. Unfortunately, prematurity raises barriers for the initiation of MOM feeding and its continuation. Mother and child are separated in most institutions, sucking and swallowing is immature, and respiratory support hinders breastfeeding. As part of a quality-improvement project, we review the published evidence on risk factors of sustained MOM feeding in preterm neonates. Modifiable factors such as timing of skin-to-skin contact, strategies of milk expression, and infant feeding or mode of delivery have been described. Other factors such as gestational age or neonatal complications are unmodifiable, but their recognition allows targeted interventions to improve MOM feeding. All preterm newborns below 34 weeks gestational age discharged over a two-year period from our large German level III neonatal center were reviewed to compare institutional data with the published evidence regarding MOM feeding at discharge from hospital. Based on local data, a risk score for non-MOM feeding can be calculated that helps to identify mother–baby dyads at risk of non-MOM feeding. Full article
(This article belongs to the Special Issue Optimizing Nutrition and Dietary Pattern in Premature Infants)
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Review

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13 pages, 387 KiB  
Review
Optimizing Early Neonatal Nutrition and Dietary Pattern in Premature Infants
by Cornelia Wiechers, Wolfgang Bernhard, Rangmar Goelz, Christian F. Poets and Axel R. Franz
Int. J. Environ. Res. Public Health 2021, 18(14), 7544; https://doi.org/10.3390/ijerph18147544 - 15 Jul 2021
Cited by 12 | Viewed by 5412
Abstract
Providing adequate amounts of all essential macro- and micronutrients to preterm infants during the period of extraordinarily rapid growth from 24 to 34 weeks’ postmenstrual age to achieve growth as in utero is challenging yet important, since early growth restriction and suboptimal neonatal [...] Read more.
Providing adequate amounts of all essential macro- and micronutrients to preterm infants during the period of extraordinarily rapid growth from 24 to 34 weeks’ postmenstrual age to achieve growth as in utero is challenging yet important, since early growth restriction and suboptimal neonatal nutrition have been identified as risk factors for adverse long-term development. Along with now well-established early parenteral nutrition, this review emphasizes enteral nutrition, which should be started early and rapidly increased. To minimize the side effects of parenteral nutrition and improve outcomes, early full enteral nutrition based on expressed mothers’ own milk is an important goal. Although neonatal nutrition has improved in recent decades, existing knowledge about, for example, the optimal composition and duration of parenteral nutrition, practical aspects of the transition to full enteral nutrition or the need for breast milk fortification is limited and intensively discussed. Therefore, further prospective studies on various aspects of preterm infant feeding are needed, especially with regard to the effects on long-term outcomes. This narrative review will summarize currently available and still missing evidence regarding optimal preterm infant nutrition, with emphasis on enteral nutrition and early postnatal growth, and deduce a practical approach. Full article
(This article belongs to the Special Issue Optimizing Nutrition and Dietary Pattern in Premature Infants)
20 pages, 2349 KiB  
Review
The Role of Nutrition in the Prevention and Management of Bronchopulmonary Dysplasia: A Literature Review and Clinical Approach
by Gustavo Rocha, Hercília Guimarães and Luís Pereira-da-Silva
Int. J. Environ. Res. Public Health 2021, 18(12), 6245; https://doi.org/10.3390/ijerph18126245 - 9 Jun 2021
Cited by 33 | Viewed by 9832
Abstract
Bronchopulmonary dysplasia (BPD) remains the most common severe complication of preterm birth, and nutrition plays a crucial role in lung growth and repair. A practical nutritional approach for infants at risk of BPD or with established BPD is provided based on a comprehensive [...] Read more.
Bronchopulmonary dysplasia (BPD) remains the most common severe complication of preterm birth, and nutrition plays a crucial role in lung growth and repair. A practical nutritional approach for infants at risk of BPD or with established BPD is provided based on a comprehensive literature review. Ideally, infants with BPD should receive a fluid intake of not more than 135–150 mL/kg/day and an energy intake of 120–150 kcal/kg/day. Providing high energy in low volume remains a challenge and is the main cause of growth restriction in these infants. They need a nutritional strategy that encompasses early aggressive parenteral nutrition and the initiation of concentrated feedings of energy and nutrients. The order of priority is fortified mother’s own milk, followed by fortified donor milk and preterm enriched formulas. Functional nutrient supplements with a potential protective role against BPD are revisited, despite the limited evidence of their efficacy. Specialized nutritional strategies may be necessary to overcome difficulties common in BPD infants, such as gastroesophageal reflux and poorly coordinated feeding. Planning nutrition support after discharge requires a multidisciplinary approach to deal with multiple potential problems. Regular monitoring based on anthropometry and biochemical markers is needed to guide the nutritional intervention. Full article
(This article belongs to the Special Issue Optimizing Nutrition and Dietary Pattern in Premature Infants)
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Other

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10 pages, 550 KiB  
Study Protocol
Customized Human Milk Fortification Based on Measured Human Milk Composition to Improve the Quality of Growth in Very Preterm Infants: A Mixed-Cohort Study Protocol
by Manuela Cardoso, Daniel Virella, Israel Macedo, Diana Silva and Luís Pereira-da-Silva
Int. J. Environ. Res. Public Health 2021, 18(2), 823; https://doi.org/10.3390/ijerph18020823 - 19 Jan 2021
Cited by 7 | Viewed by 3514
Abstract
Adequate nutrition of very preterm infants comprises fortification of human milk (HM), which helps to improve their nutrition and health. Standard HM fortification involves a fixed dose of a multi-nutrient HM fortifier, regardless of the composition of HM. This fortification method requires regular [...] Read more.
Adequate nutrition of very preterm infants comprises fortification of human milk (HM), which helps to improve their nutrition and health. Standard HM fortification involves a fixed dose of a multi-nutrient HM fortifier, regardless of the composition of HM. This fortification method requires regular measurements of HM composition and has been suggested to be a more accurate fortification method. This observational study protocol is designed to assess whether the target HM fortification method (contemporary cohort) improves the energy and macronutrient intakes and the quality of growth of very preterm infants, compared with the previously used standard HM fortification (historical cohorts). In the contemporary cohort, a HM multi-nutrient fortifier and modular supplements of protein and fat are used for HM fortification, and the enteral nutrition recommendations of the European Society for Paediatric Gastroenterology Hepatology and Nutrition for preterm infants will be considered. For both cohorts, the composition of HM is assessed using the Miris Human Milk analyzer (Uppsala, Sweden). The quality of growth will be assessed by in-hospital weight, length, and head circumference growth velocities and a single measurement of adiposity (fat mass percentage and fat mass index) performed just after discharge, using the air displacement plethysmography method (Pea Pod, Cosmed, Italy). ClinicalTrials.gov registration number: NCT04400396. Full article
(This article belongs to the Special Issue Optimizing Nutrition and Dietary Pattern in Premature Infants)
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