Abstract
As preterm birth rates are globally increasing, together with research on preterms’ peculiar needs, neonatologists are still facing the challenge of how to properly feed them. The need to strike a balance between excessive catch-up growth and extrauterine growth retardation, both leading to adverse outcomes, is made even more difficult by the broad range of preterms’ needs. Although mother’s fresh milk is undoubtedly the best nourishment, its availability during hospital stay is often lower than recommended, and its fortification at discharge is still an open issue. Formula milks are available as an alternative to breast milk. However, choosing the right formula requires a thorough evaluation of the infant’s perinatal history and targets. Last but not least, adequate timing and initiation of weaning in premature babies are still a poorly explored matter. This narrative review aims at evaluating the multitude of issues to consider when feeding preterms in the three stages of their first life: in-hospital care, discharge, and, eventually, weaning. Given the current absence of internationally shared guidelines, understanding the potential pitfalls of preterms’ nutrition could help us trace the right path for the right preterm.
Highlights
Preterm newborns account for 11% of live births in the world every day [1]
Nutrition in the first 1000 days of life can play a pivotal role in this vulnerable population and especially in low birth weight (LBW) preterm babies
adequate for gestational age (AGA) at birth but with extrauterine growth retardation (EUGR); (iii) neonates small for gestational age (SGA) at birth without catch-up growth at discharge; (iv) neonates SGA at birth but with early catch-up growth at discharge. Such a distinction is limited by the lack of consensus on EUGR definition: the cross-sectional definition consists of a weight below the 10th or 3rd centile at a given time, regardless of birth weight; the longitudinal definition refers to EUGR as a weight loss of more than 1 Standard Deviations between birth and a given time
Summary
Preterm newborns account for 11% of live births in the world every day [1]. Prematurity is the leading cause of newborn mortality and morbidity in the first years of life. Despite great advances in perinatal assistance and ongoing research, we are still not able to fully recreate the womb environment [2]. Preterm infants complete their organogenesis in a non-physiological environment. Nutrition in the first 1000 days of life can play a pivotal role in this vulnerable population and especially in low birth weight (LBW) preterm babies. Despite increasing evidence demonstrating that guidelines for term infants’ weaning are not applicable to the preterm population, to date, no specific recommendation for premature babies is universally accepted [5,7,8]. The aim of the present narrative review is to provide an update on the available evidence on preterm nutrition, from the hospital setting to weaning
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