Baby J, a premature baby, had been discharged from the NICU for a week, but when he came to see the child health care provider as prescribed, he was told that he had failed the growth assessment. The whole family has been taking good care of him, but he failed? How can I feed my baby?
Types of milk for premature babies.
1, breast milk: the energy density of breast milk is 67kcal/100 ml.
2, breast milk fortification: contains protein, minerals and vitamins. Generally fortified breastmilk prepared according to the standard has an energy density of 80 to 85 kcal/100 ml.
3.Premature formula: special formula for premature babies during hospitalization, with a dense energy density of 80 kcal/100 ml.
4.Post-discharge formula for preterm infants: specially designed for preterm infants during the post-discharge transition period, providing energy and nutrients between preterm formula and infant formula, with a dense energy density of 73 kcal/100 ml.
5. Infant formula: formula for normal full-term infants, with an energy density of 67kcal/100 ml.
Of course, in addition to the energy density of these milks, there are also differences in the content and types of nutrients such as protein, minerals and vitamins.
Feeding options.
Although preterm infants can meet the following conditions at discharge: weight up to 2000 g, tolerated by oral feeding, stable body temperature and all vital signs at room temperature, etc., the choice of feeding method varies depending on gestational age, birth weight, and complications.
1.Breast milk: For preterm infants with birth weight > 2000 g and no risk factors for malnutrition, breast milk is the first choice after discharge from hospital.
2.Breast milk + breast milk fortification: for very low birth weight infants and those with poor pre-discharge nutritional status evaluation, intensive breastfeeding until 40 weeks of gestational age. Thereafter reduce the energy density, such as half amount of fortification according to growth (73 kcal/100 ml), added to breast milk in a certain ratio (not directly in water or added to formula).
3.Formula for preterm infants: it is suitable for those whose gestational age is <34 weeks and birth weight is <2000, usually for use during hospitalization.
4.Post-discharge formula for preterm infants: it is suitable for artificially fed preterm infants or as a supplement to breast milk.
5.Infant formula: applicable to preterm infants with birth weight > 2000 grams, no risk factors for malnutrition and satisfactory weight gain after discharge.
How long does the intensive nutrition last?
Post-discharge fortified nutrition for preterm infants refers to the method of feeding with fortified breast milk and post-discharge formula for preterm infants. On the one hand, preterm infants are born with insufficient nutritional reserves and need more nutrients for catch-up growth after birth; on the other hand, the immature development of the gastrointestinal tract and poor digestion and absorption ability make the contradiction between supply and demand prominent, so fortified nutrition becomes a good choice for some preterm infants. Fortified nutrition can ensure good growth and neurological prognosis of preterm infants, but overfeeding can increase the risk of chronic diseases in adulthood, such as obesity and metabolic syndrome. How to strike a balance between the two and manage the timing of fortification?
Nutrition is generally fortified until 3 months to 6 months of corrected age (from prenatal date) and up to 1 year of age. For each individual, when to switch to breastfeeding should be done under the guidance of a doctor. The doctor will calculate the growth rate based on the measured weight, length and head circumference; consult the percentile table to compare the corrected age with the growth standard of a full-term baby; and monitor the blood biochemical indicators for a comprehensive analysis and judgment to develop a plan for your baby.
When switching to formula, a gradual approach should be taken. If you only add 1 new formula a day at the beginning and use the old formula for the rest of the day, observe 2~3 days to adapt to the new formula and then increase it to 2 times a day until it is completely replaced by the new formula. In the process of conversion, babies may not be used to the new taste or intolerance, but they will slowly adapt to it, do not rush.
How to add complementary foods (transitional food introduction)?
Usually no earlier than 4 months of corrective age and no later than 6 months. If you add complementary foods too early, vomiting and diarrhea may occur due to immature gastrointestinal tract function; if you add them too late, it will affect the acquisition of various nutrients and cause feeding difficulties. Within 1 year of age, dairy products are the staple food and the amount of milk should not be less than 600 ml. The amount of complementary foods should not be too much, but there should be many kinds in order to obtain sufficient and balanced nutrients and to develop good habits of not being picky. For more information on adding complementary foods, please refer to the article “The ABCs of complementary foods for infants”.
Goals of nutritional management for preterm infants.
1.Promote catch-up growth.
2.Prevent nutritional deficiencies and excesses.
3.Ensure the development of the nervous system.
4.Benefit long term health.