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New approaches to optimizing early diets
1Neonatal Intensive Care Unit, Department of Paediatrics, University Hospital, Lund, Sweden.
Insights
Optimal nutrition is crucial for extremely low birthweight (ELBW) infants. This study details a Swedish approach using mother's own milk, banked milk, and fortification, with regular analysis, to ensure adequate protein and energy for brain development.
Area of Science:
- Neonatal intensive care
- Pediatric nutrition
- Human milk analysis
Background:
- Extremely low birthweight (ELBW) infants require specialized nutrition for survival and brain development.
- Human milk offers significant advantages over infant formula for these vulnerable infants.
- Nutritional content of human milk varies considerably, necessitating careful management.
Purpose of the Study:
- To describe a nutritional strategy for ELBW infants in Sweden.
- To optimize protein and energy intake through tailored milk feeding.
- To ensure adequate growth and development in ELBW infants.
Main Methods:
- Individualized feeding with mother's own milk and banked milk.
- Weekly infrared macronutrient analysis of 24-hour milk collections.
- Fortification of milk and continued parenteral nutrition until enteral intake is sufficient.
- Monitoring of protein markers (serum urea, transthyretin) and growth parameters.
Main Results:
- A system for analyzing and utilizing banked milk based on protein content.
- Implementation of milk fortification to meet specific protein and energy targets.
- Parenteral nutrition was used as a supplement until enteral feeding reached 75-80% of total intake.
- Growth and protein markers were monitored to assess nutritional adequacy.
Conclusions:
- This comprehensive nutritional approach supports the growth and development of ELBW infants.
- Individualized analysis and fortification of human milk are key components of optimal neonatal nutrition.
- Close monitoring of biochemical markers and growth ensures infants receive adequate nutrition.
Abstract:
Most extremely low birthweight (ELBW; <1,000 g) infants will survive if cared for at a tertiary neonatal intensive care unit, and should be given optimal nutrition for brain development. Human milk confers nutritional and non-nutritional advantages over infant formula, and is started during the first hours of life. In Sweden, most ELBW infants are fed individually with mother's own milk (preferred) and banked milk, with supplementary parenteral nutrition. There is an enormous variation particularly in the fat and protein content of milk between mothers, during the day and the course of lactation. Infrared macronutrient analyses on 24-hour collections of mother's milk are performed once a week allowing for optimal protein and energy intakes. All banked milk is analyzed, and the most protein-rich milk is given to a newborn ELBW infant. After 2 weeks, the milk may be fortified if the protein or energy intakes need to be further increased, and fortification is continued throughout the tube-feeding period. Parenteral nutrition is continued until the enteral intake constitutes 75-80% of the total volume intake. Protein markers, e.g. serum urea and transthyretin, are assessed, and growth is monitored by measurements of weight, crown-heel length and head circumference.
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