Premature infants have a lot of special nutrition needs. Combined with their tiny bodies and tinier stomachs, making sure these babies get what they need is a big concern for parents.
At birth, premature infants’ brains, organs, bones and other tissues have not yet fully developed, explains registered dietitian Michelle Johnson, a pediatric nutrition scientist at Abbot Nutrition and neonatal intensive care unit clinical nutritionist. The roughly 1 in 10 U.S. babies who are born before 37 weeks of gestation each year have an increased risk of infant death, developmental delays, neurological and behavioral disorders, vision loss, asthma and other complications that can extend into adulthood, according to the Centers for Disease Control and Prevention.
Nutrition is critical to giving these babies the best start possible, Johnson says. She explains that the nutrients they consume serve as building blocks to help them grow and develop.
Exactly how the nutritional needs of preemies vary from those of full-term infants is based on how prematurely the baby was born. That’s why, for parents of premature infants, it’s important to partner with health care providers, including any NICU staff, to establish the best nutritional plan for your individual baby’s needs, says Nicole Avena, assistant professor of neuroscience at the Mount Sinai School of Medicine and author of “What to Feed Your Baby and Toddler.”
However, across the board, there are some important considerations all parents of premature infants should make. Here, experts share four nutritional tips to help little ones thrive.
Give small, frequent feedings. Preterm infants have tiny bellies that are still developing and can’t hold as much as those of full-term infants. At birth, some premature infants can only hold up to a teaspoon of liquid and will receive such feedings in the hospital, sometimes with a nasogastric tube (or NG tube), Johnson says. That’s because, at birth, some premature infants have not yet mastered sucking and swallowing — let alone coordinating both with breathing.
Babies can go home from the hospital only after they are able to properly breast or bottle feed, and will typically eat small amounts (for example, about 3 teaspoons for a 2-pound baby) every three hours around the clock. Over time, your infant’s stomach will grow to hold the same amount as a full-term baby’s does at 37 weeks, or up to 1 or 2 ounces (one-eighth to one-fourth cup) up to eight to 12 times per day, Johnson says.
Talk to your pediatrician about supplementation. ” Breast milk is the best feeding for all infants, but providing more breast milk in an attempt to meet preterm infants’ nutrient needs can provide too much fluid to these fragile babies,” Johnson says. “Human milk fortifier is often added to breast milk for premature babies to add essential nutrients to their feedings.” For example, a 2016 review published in the Journal of Pediatric Gastroenterology and Nutrition shows that lutein supplementation may support eye development in premature infants.
Meanwhile, human milk oligosaccharides are the third-most-abundant component in breast milk, and they serve as powerful prebiotics that feed the good bacteria in baby’s guts and promote immune function. It’s these compounds that are largely responsible for the “breast is best” mantra. Experts including Johnson still recommend breastfeeding when possible. However, when contained in infant formula, 2′-FL or 2′-Fucosyllactose HMO supports immune development similarly to 2′-FL naturally found in human breast milk, according to 2016 research published in The Journal of Nutrition.
In the hospital, trained health care professionals combine human milk fortifier or premature infant formula, if needed, with breast milk to provide the baby additional nutrients including protein, vitamins and minerals. Ask your baby’s health care team what, if any, supplements such as premature formula and human milk fortifier are needed once baby comes home. “It is not recommended to fortify breast milk unless instructed by a pediatrician, and the amount of formula added to the breast milk may vary depending on the brand of formula,” Avena says.
Ease digestion. “Some preterm infants may not have fully developed gastrointestinal systems and may also have difficulty sucking or swallowing at first,” Avena says. Keeping feedings small and frequent can help, but for those infants who still have trouble, special easy-to-digest formulas can be beneficial. To help premature babies digest and properly absorb needed nutrients, some premature infant formulas and human milk fortifiers are “hydrolyzed,” meaning their protein has already been broken down. Talk to your baby’s doctor about available formulas to find the right one for your infant’s digestive system.
“By the time preterm infants reach the age when solids are introduced at six months, most have caught up developmentally and can start on solids, but some may require a special diet,” Avena says. “This is why it is important to discuss any feeding concerns with your pediatrician, as every preterm case is different.”
Keep things clean. Cleanliness is always a priority when handling breast milk or formula, but it’s good to remember that preterm infants often have underdeveloped immune systems and can be more prone to infection and complications, Johnson says.
“Some important steps for safe feeding preparation to help keep preterm babies healthy include use of a clean space and equipment to prepare feedings; following hospital guidelines for collection, storage and transportation of mother’s milk; and following manufacturer’s recommendations for preparation and use of human milk fortifiers and formulas,” Johnson says. What’s more, she notes that whether bottle-feeding, breastfeeding or pumping for breast milk, it’s important for all caregivers to wash their hands with soap and water before handling a feeding and for mothers to wash their hands just prior to handling their breasts.
Avena also recommends cleansing the mother’s nipple with water or breast milk to help reduce germs, but to avoid soaps, which can leave residue and dry the skin. And “when handling human milk fortifiers, try to opt for prepackaged single servings that come in sterile packaging. These are easier to keep clean compared to large-tub powdered varieties,” Avena says.
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