Immunonutrition for Preterm Infants

Area of Science:

• Neonatal care
• Infant nutrition
• Gastroenterology

Background:

• Very preterm infants face significant mortality and morbidity risks, including necrotising enterocolitis (NEC) and infections, often linked to prolonged hospitalisation and feeding strategies.
• The immature infant gut's microbial and metabolic balance is influenced by enteral diet, particularly immunonutrients in breast milk, impacting NEC and neurodevelopmental outcomes.

Purpose of the Study:

• To review current evidence on nutritional strategies for very preterm infants to reduce NEC, late-onset infection, and associated morbidities.
• To evaluate the role of maternal breast milk, donor milk, immunonutrients, prebiotics, and probiotics in improving outcomes for extremely premature infants.

Main Methods:

• Systematic review of existing literature and randomised controlled trials on infant nutrition and NEC prevention.
• Analysis of the impact of various enteral feeding components and strategies on the gut microbiome and immune function in preterm neonates.

Main Results:

• Human breast milk is supported as the primary nutrition source; pasteurised donor milk offers some NEC protection but has unclear nutritional adequacy and cost-effectiveness.
• Supplementation with individual immunonutrients has not proven effective in preventing NEC or infection. Evidence for prebiotics and probiotics is stronger, but formulation concerns remain.
• Strategies like avoiding gastric acid suppressants and implementing evidence-based feeding protocols are emerging as vital for reducing NEC, infection, and growth faltering.

Conclusions:

• Optimising enteral nutrition, prioritising maternal breast milk, and judicious use of prebiotics/probiotics are key to improving outcomes for very preterm infants.
• Further research is needed on the optimal use and safety of nutritional interventions, including donor milk and probiotics, for this vulnerable population.