Growth and micronutrient status parameters of Nigerian preterm infants consuming preterm formula or breastmilk
Adedotun Joshua Owolabi1, Idowu Adejumoke Ayede2, Olugbenga Oyewumi Akinrinoye2
1Division of Human Nutrition and Health, Wageningen University and Research, P.O. Box 9101, 6700 HB, Wageningen, The Netherlands. adedotunowolabi@gmail.com.
Insights
Breastfeeding supports adequate growth in moderate-to-late preterm infants, but may be insufficient in certain micronutrients. Preterm formula ensures adequate micronutrient intake, though it may lead to faster weight gain than recommended.
Area of Science:
- Neonatal Nutrition
- Pediatric Gastroenterology
- Infant Development
Background:
- Moderate-to-late preterm infants (32-34 weeks gestational age) face higher neonatal morbidity risks than term infants.
- Existing nutritional guidelines for this population are limited.
- This study addresses the nutritional needs of moderate-to-late preterm infants.
Purpose of the Study:
- To compare the growth and micronutrient status of moderate-to-late preterm infants fed either preterm formula or breastmilk.
- To evaluate the adequacy of micronutrient delivery through different feeding methods.
- To inform the development of dedicated nutritional guidelines for this vulnerable group.
Main Methods:
- An observational, open-label study involving 41 moderate-to-late preterm infants.
- Infants were fed either preterm formula (n=17) or breastmilk (n=24) from 2 to 10 weeks of age.
- Anthropometric measurements were taken bi-weekly, and blood concentrations of hemoglobin, ferritin, serum retinol, and 25-hydroxy-vitamin D were analyzed at 2 and 10 weeks.
Main Results:
- Both feeding groups showed comparable average daily weight gain (14.7 g/kg BW/day for formula vs. 12.8 g/kg BW/day for breastmilk).
- Length and head circumference were consistent with Fenton growth chart references for both groups.
- Formula feeding was associated with higher hemoglobin levels at 10 weeks and significant increases in serum retinol and 25-hydroxy-vitamin D, while breastmilk feeding showed a notable increase in 25-hydroxy-vitamin D only.
Conclusions:
- While unfortified breastmilk supports adequate physical growth in moderate-to-late preterm infants, monitoring of vitamin D, vitamin A, and iron is crucial.
- Preterm formula adequately supplies micronutrients and may result in higher weight gain velocity than reference values.
- This study underscores the need for specific nutritional guidelines and regular monitoring for moderate-to-late preterm infants.
Background:
Moderate-to-late preterm infants (32-34 weeks GA) have increased risk of neonatal morbidities compared to term infants, however dedicated nutritional guidelines are lacking.
Methods:
Moderate-to-late preterm infants received a preterm formula (n = 17) or breastmilk (n = 24) from age 2-10 weeks in a non-randomized, open-label observational study. Anthropometric measurements were assessed bi-weekly. Blood concentrations of hemoglobin, ferritin, serum retinol, and 25-hydroxy-vitamin D (25OHD) were analyzed at age 2 and 10 weeks.
Result:
Average growth per day was 14.7 g/kg BW/day in formula-fed and 12.8 g/kg BW/day in breastmilk-fed infants but not different from each other. Length and head circumference in both groups were in line with the median reference values of the Fenton growth chart. At 10 weeks of age, hemoglobin tended to be higher in the formula-fed group (10.2 g/dL vs. 9.6 g/dL, p = 0.053). 25OHD increased in formula- and breastmilk-fed infants from 73.8 to 180.9 nmol/L and from 70.7 to 97.6 nmol/L, respectively. Serum retinol only increased in the formula-fed group (0.63 to 1.02 µmol/L, p < 0.001).
Conclusion:
Breastfeeding resulted in adequate growth in moderate-late preterm infants but was limiting in some micronutrients. The preterm formula provided adequate micronutrients, but weight gain velocity was higher than the Fenton reference value.
Impact Statement:
Unfortified breastmilk resulted in adequate growth in weight, length and head circumference in Nigerian moderate to late preterm infants during an study period of 8 weeks, but status of vitamin D, vitamin A and iron needs to be monitored. The high-energy formula, developed for very preterm infants, resulted in higher growth in body weight in moderate to late preterm infants than the median of the Fenton preterm growth chart. This study supports the necessity of dedicated nutritional guidelines, and regular monitoring of growth and nutritional status of moderate to late preterm infants.
