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Promoting growth for preterm infants following hospital discharge
J A Morgan1, L Young, F M McCormick
1Centre for Reviews and Dissemination, Hull York Medical School, University of York, UK.
Insights
Nutrient fortification of breast milk may aid catch-up growth in preterm infants, but evidence is limited. Further research is needed to optimize strategies for promoting healthy growth post-discharge.
Area of Science:
- Neonatology
- Pediatric Nutrition
- Growth and Development
Background:
- Preterm infants, particularly very preterm infants, often experience growth restriction upon hospital discharge.
- Interventions like multinutrient fortification of breast milk and specialized formula are proposed to enhance catch-up growth.
- Current evidence supporting these post-discharge feeding strategies remains limited.
Purpose of the Study:
- To review the existing evidence on feeding strategies aimed at promoting catch-up growth in preterm infants after hospital discharge.
- To identify gaps in knowledge regarding the efficacy of nutrient fortification and enriched formulas.
- To suggest future research directions for optimizing nutritional support in this vulnerable population.
Main Methods:
- Review of current scientific literature and clinical trial data on preterm infant nutrition post-discharge.
- Analysis of studies evaluating expressed breast milk fortification and specialized infant formulas.
- Assessment of growth parameters and developmental outcomes in preterm infants receiving different nutritional interventions.
Main Results:
- Fortification of expressed breast milk may positively influence weight gain and skeletal/head growth, but requires further investigation into specific nutrients and target populations.
- Studies comparing nutrient-enriched formula milk with standard formula have not shown consistent benefits in growth or development.
- Infants fed ad libitum may compensate for increased formula calorie density by reducing intake, potentially explaining the lack of observed growth differences.
Conclusions:
- While expressed breast milk fortification shows potential, more research is essential to determine optimal nutrient composition and identify infants most likely to benefit.
- Commercially available nutrient-enriched formulas have not demonstrated consistent advantages over standard formulas for preterm infant growth.
- Future research should prioritize evaluating protein and mineral-enriched formulas, focusing on lean mass and skeletal growth, rather than energy enrichment.
Abstract:
Preterm infants, especially very preterm infants, are usually growth-restricted at the time of hospital discharge. Proposed interventions to promote catch-up growth following hospital discharge include multinutrient fortification of expressed breast milk for breastfed infants and nutrient-enriched formula milk for formula-fed infants. The current evidence to support these strategies is limited. Fortification of expressed breast milk may increase weight gain and skeletal and head growth during infancy, but more research is needed to define which nutrients confer most benefit, and which population of infants is likely to receive most benefit. Trials that have assessed feeding preterm infants with commercially available nutrient-enriched formula milk ('preterm' or 'postdischarge' formulae) compared with standard formula milk have not found consistent evidence of an effect on growth parameters or development, probably because ad libitum fed infants reduce their intake relative to the calorie-density of the milk. Future studies should focus on the effect of formulae enriched with protein and minerals rather than energy and assess the effect on lean mass and skeletal growth.
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