Abstract
Preterm infants have a lower level of nutrient body stores and immature body systems, resulting in a higher risk of malnutrition. Imbalanced complementary feeding could lead to further risk of nutritional deficits and excesses. However, evidence on their nutritional requirements following hospital discharge is limited. When planning complementary feeding, appropriate micronutrient intake should be considered for their critical role in supporting various body functions. This narrative review summarizes the need for iron, zinc, vitamin D, calcium, phosphate and long-chain polyunsaturated fatty acids (LCPUFAs) supplementation in preterm infants during complementary feeding. Regarding iron and vitamin D, the scientific community is reaching an agreement on supplementation in some categories of prematures. On the contrary, there is still not enough evidence to detail possible recommendations for LCPUFAs, zinc, calcium and phosphorus supplementation. However, these micronutrients are paramount for preterms’ health: LCPUFAs can promote retinal and brain development while calcium and phosphorus supplementation is essential to prevent preterms’ metabolic bone disease (MBD). Waiting for a consensus on these micronutrients, it is clear how the knowledge of the heterogeneity of the prematures population can help adjust the nutritional planning regarding the growth rate, comorbidities and comprehensive clinical history of the preterm infant.
Highlights
Fetal development and infancy represent a critical time window for shaping future health due to various organs’ extraordinary plasticity and their sensitivity to nutrition and other environmental triggers during this phase [1]
Increasing evidence indicates that appropriate nutritional management dramatically reduces the risk of comorbidity development, such as sepsis, metabolic bone disease (MBD) and severe retinopathy of prematurity and the optimization of neurodevelopment outcomes [5,6]
There is a consensus on the preterm infants’ nutritional requirements during the hospital stay, with early enteral and parenteral support being the cornerstone of their nutritional management [7,8]
Summary
Fetal development and infancy represent a critical time window for shaping future health due to various organs’ extraordinary plasticity and their sensitivity to nutrition and other environmental triggers during this phase [1]. There has been a shared call for more restrictive blood transfusion policies in particular for the extremely preterm neonates, because of the demonstrated associations between early exposure to blood transfusions, and increased mortality and short-term morbidities [28] Within this context, when planning iron supplementation at discharge, the clinical history of the preterm infant should be taken into account, from the number and date of blood transfusions received to the type of feeding. Given the increased risk of iron deficiency associated with prematurity and low birth weight, we suggest monitoring the iron storage status at discharge, during follow-up and at the beginning of complementary feeding in order to tailor iron supplementation dose and duration and offer the most appropriate solid foods. We do not recommend serial measurements of its concentration unless evidence of zinc deficiency is detectable (Table 2)
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