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Turkish Neonatal Society guideline on enteral feeding of the preterm infant
Nilgün Kültürsay1, Hülya Bilgen2, Canan Türkyılmaz3
1Division of Neonatology, Department of Pediatrics, Ege University, Faculty of Medicine, İzmir, Turkey.
Insights
Early nutrition for preterm infants focuses on mother's milk to prevent growth failure. Strategies include early enteral feeding, milk expression support, and tailored post-discharge plans for optimal development.
Area of Science:
- Neonatology
- Pediatric Nutrition
- Infant Development
Background:
- Postnatal growth failure is a significant concern in preterm infants.
- Optimal nutrition is critical for preterm infant development and long-term health.
Purpose of the Study:
- To outline strategies for early enteral feeding in preterm infants.
- To emphasize the importance of mother's milk and supportive feeding practices.
- To address nutritional needs from birth through post-discharge.
Main Methods:
- Initiation of minimal enteral nutrition with colostrum within hours of birth.
- Gradual advancement of expressed mother's milk via gastric tube based on infant parameters.
- Inclusion of total parenteral nutrition, mouth care, and non-nutritive feeding support.
Main Results:
- Targeting full enteral feeding within 1-2 weeks, depending on birth weight.
- Highlighting the crucial role of maternal support for milk expression and kangaroo care.
- Recommending donor milk or preterm formula when mother's milk is unavailable.
Conclusions:
- Early and optimized nutrition, primarily with mother's milk, is key for preterm infant growth and neurodevelopment.
- Tailored nutrition plans, including post-discharge, are essential for preventing long-term metabolic issues.
- Late preterm infants require dedicated nutritional attention and follow-up.
Abstract:
Early initiation of enteral feeding with the own mother's milk and prevention of postnatal growth failure is the target of nutrition in preterm infants. Together with total parenteral nutrition, mouth care and minimal enteral nutrition is started with colostrum in the very early hours of life in small preterm infants. Expressed mother's milk is given via a gastric tube and gradually increased in accordance with the gestational age/birth weight and the risk factors. For infants born heavier than 1 000 grams, the aim is to reach total enteral feeding at the end of first week, and at the end of the second week for infants weighing less than 1000 grams. Supporting mothers in milk expression and kangaroo mother care, promoting non-nutritive feeding, appropriate fortification of mother' milk, and initiating and advancing breastfeeding as soon as the infant is ready are all crucial. Donor mother milk, and as a second choice, preterm formula is advised if the mother's milk is not available. Individualized post-discharge nutrition decisions can be taken in accordance with the actual growth at the time of discharge. The goal is optimal neurodevelopmental achievement together with the prevention of long-term metabolic problems. Late preterm infants, which constitute the majority of preterm infants, also need close nutritional attention and follow-up.
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