Deficiency or excess of specific micronutrients is common in preterm infants and can have many effects on health outcomes, ranging from life-threatening electrolyte disturbances to long-term effects on growth, brain development, bone health, and the risk of retinopathy of prematurity (ROP). Iron supplementation of low birth weight infants reduces the risk of behavioral problems. However, due to the risk of adverse effects, iron supplementation of very preterm infants in the NICU should be individualized, considering birth weight, postnatal age, diet, and serum ferritin concentrations. Sodium intakes should be minimized during the first 3 days of life in very preterm infants to avoid hypernatremia. However, after 4 days of age, sodium supplements can reduce hyponatremia and improve growth. Adequate parenteral and enteral calcium and phosphorus intakes are crucial for the prevention of osteopenia of prematurity. Screening of serum phosphate concentrations is useful. Deficiencies of docosahexaenoic acid (DHA) and arachidonic acid (AA) are frequently observed in extremely preterm infants. A recent Swedish study suggests that combined DHA and AA supplementation may reduce the risk of severe ROP. When prescribing enteral and parenteral nutrition for preterm infants, it is important to consider micronutrients. Many preterm infants will need different micronutrient supplements.
{"title":"Micronutrient Intakes and Health Outcomes in Preterm Infants.","authors":"M. Domellöf","doi":"10.1159/000519393","DOIUrl":"https://doi.org/10.1159/000519393","url":null,"abstract":"Deficiency or excess of specific micronutrients is common in preterm infants and can have many effects on health outcomes, ranging from life-threatening electrolyte disturbances to long-term effects on growth, brain development, bone health, and the risk of retinopathy of prematurity (ROP). Iron supplementation of low birth weight infants reduces the risk of behavioral problems. However, due to the risk of adverse effects, iron supplementation of very preterm infants in the NICU should be individualized, considering birth weight, postnatal age, diet, and serum ferritin concentrations. Sodium intakes should be minimized during the first 3 days of life in very preterm infants to avoid hypernatremia. However, after 4 days of age, sodium supplements can reduce hyponatremia and improve growth. Adequate parenteral and enteral calcium and phosphorus intakes are crucial for the prevention of osteopenia of prematurity. Screening of serum phosphate concentrations is useful. Deficiencies of docosahexaenoic acid (DHA) and arachidonic acid (AA) are frequently observed in extremely preterm infants. A recent Swedish study suggests that combined DHA and AA supplementation may reduce the risk of severe ROP. When prescribing enteral and parenteral nutrition for preterm infants, it is important to consider micronutrients. Many preterm infants will need different micronutrient supplements.","PeriodicalId":18986,"journal":{"name":"Nestle Nutrition Institute workshop series","volume":"30 1","pages":"130-137"},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90845310","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Infants born very preterm miss out on the in utero transfer of the omega-3 and omega-6 long-chain polyunsaturated fatty acids that occurs during the third trimester. A number of studies have explored the impact of increasing the enteral intakes of omega-3 +/- omega-6 long-chain polyunsaturated fatty acids to match fetal accretion rates in such infants. These studies have shown early transient improvements in vision and development with both strategies, but with the use of omega-3 supplementation alone appearing to increase the incidence of bronchopulmonary dysplasia. A recent study of omega-3 + omega-6 supplementation demonstrated a significant reduction in the incidence of severe retinopathy of prematurity in a high-risk population, without apparent adverse effects; a larger study is needed to confirm the observed benefits, to assess safety, and to determine long-term developmental outcomes of this strategy.
{"title":"The Role of Long-Chain Polyunsaturated Fatty Acids in Very Preterm Nutrition.","authors":"A. McPhee, C. Collins, R. Gibson, M. Makrides","doi":"10.1159/000519392","DOIUrl":"https://doi.org/10.1159/000519392","url":null,"abstract":"Infants born very preterm miss out on the in utero transfer of the omega-3 and omega-6 long-chain polyunsaturated fatty acids that occurs during the third trimester. A number of studies have explored the impact of increasing the enteral intakes of omega-3 +/- omega-6 long-chain polyunsaturated fatty acids to match fetal accretion rates in such infants. These studies have shown early transient improvements in vision and development with both strategies, but with the use of omega-3 supplementation alone appearing to increase the incidence of bronchopulmonary dysplasia. A recent study of omega-3 + omega-6 supplementation demonstrated a significant reduction in the incidence of severe retinopathy of prematurity in a high-risk population, without apparent adverse effects; a larger study is needed to confirm the observed benefits, to assess safety, and to determine long-term developmental outcomes of this strategy.","PeriodicalId":18986,"journal":{"name":"Nestle Nutrition Institute workshop series","volume":"1 1","pages":"107-115"},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90208193","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The benefits of breastfeeding, such as reduced risk of gastrointestinal and respiratory tract infections, depend largely on the presence of bioactive compounds in breast milk, including human milk oligosaccharides (HMOs). The presence of HMOs represents one of the largest differences in composition between breast milk and infant formula. Currently, progress in biotechnology allows the production of selected HMOs such as 2'-fucosyllactose (2'-FL) and lacto-N-neotetraose (LNnT), which are increasingly being added to infant formulas to narrow the difference between breast milk and formula. It is important to differentiate HMOs naturally occurring in human breast milk from those biotechnologically produced, which, while identical to HMOs in breast milk, do not originate from breast milk. This chapter summarizes basic facts about HMOs, findings from observational studies assessing the relationship between specific HMOs and clinical effects, and evidence from randomized controlled trials with structures identical to HMOs in breast milk added to infant formulas. Overall, the findings from some recently published trials provide reassurance that infant formulas supplemented with selected structures identical to HMOs, specifically 2'-FL with/out LNnT, are safe and well tolerated, and may have favorable effects on some health outcomes and medication usage. Further studies are needed.
{"title":"Selected Human Milk Oligosaccharides Added to Infant Formulas for Term Infants.","authors":"H. Szajewska","doi":"10.1159/000519388","DOIUrl":"https://doi.org/10.1159/000519388","url":null,"abstract":"The benefits of breastfeeding, such as reduced risk of gastrointestinal and respiratory tract infections, depend largely on the presence of bioactive compounds in breast milk, including human milk oligosaccharides (HMOs). The presence of HMOs represents one of the largest differences in composition between breast milk and infant formula. Currently, progress in biotechnology allows the production of selected HMOs such as 2'-fucosyllactose (2'-FL) and lacto-N-neotetraose (LNnT), which are increasingly being added to infant formulas to narrow the difference between breast milk and formula. It is important to differentiate HMOs naturally occurring in human breast milk from those biotechnologically produced, which, while identical to HMOs in breast milk, do not originate from breast milk. This chapter summarizes basic facts about HMOs, findings from observational studies assessing the relationship between specific HMOs and clinical effects, and evidence from randomized controlled trials with structures identical to HMOs in breast milk added to infant formulas. Overall, the findings from some recently published trials provide reassurance that infant formulas supplemented with selected structures identical to HMOs, specifically 2'-FL with/out LNnT, are safe and well tolerated, and may have favorable effects on some health outcomes and medication usage. Further studies are needed.","PeriodicalId":18986,"journal":{"name":"Nestle Nutrition Institute workshop series","volume":"12 1","pages":"149-159"},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89973047","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Summary on Personalized Nutrition of Preterm Infants.","authors":"F. Haschke","doi":"10.1159/000519404","DOIUrl":"https://doi.org/10.1159/000519404","url":null,"abstract":"","PeriodicalId":18986,"journal":{"name":"Nestle Nutrition Institute workshop series","volume":"867 1","pages":"138-140"},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78975445","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Donor milk (DM) is of increasing interest as primary nutritional source for preterm infants. Safe access requires special infrastructure, trained staff, sophisticated algorithms, and standard operating procedures as well as quality control measures. DM has limitations like low protein content and unpredictable composition of the other macronutrients, despite fortification frequently not meeting recommendations - both of them compromising growth. The first paragraph is devoted to COVID-19 and how it impacts processes of DM banking. The following paragraphs review aspects of "pasteurization," "safety audits/donor screening," and "DM nutrient variability." In summary, (i) Holder pasteurization still is the most suitable procedure for milk banks, but high-pressure pasteurization or ultraviolet C irradiation conserve the unique properties of DM better and deserve more research to make it suitable for clinical routine. (ii) In regard to safety/screening, guidelines are valuable for safe DM bank operation, but they differ between legislations. There is a surprisingly high rate of non-disclosed donor smoking (0.3%, p > 0.05) and of adulteration of delivered DM (up to 2%, p < 0.05) not detected by standard donor screening procedures. Frequencies differ between remunerated and non-remunerated programs. (iii) Neonatal caregivers should be aware of unpredictable composition of DM. They should be trained on how these can be overcome to avoid negative impact on growth and long-term outcomes like (a) measuring and disclosing nutrient contents of delivered DM batches to customers, (b) implementing certain types of donor pooling to reduce the risk of macronutrient depleted DM, (c) additional supplementation using 0.3-0.5 g protein/100 mL seems to be reasonable, (d) adjusted fortification may help to improve growth, but is not efficient in all preterm infants, (e) target fortification seems to improve growth (and probably also neurodevelopmental index) compared to standard fortification, (f) more research and clinical studies are needed.
{"title":"Donor Milk Banking - Safety, Efficacy, New Methodologies.","authors":"C. Fusch, C. Gebauer","doi":"10.1159/000519400","DOIUrl":"https://doi.org/10.1159/000519400","url":null,"abstract":"Donor milk (DM) is of increasing interest as primary nutritional source for preterm infants. Safe access requires special infrastructure, trained staff, sophisticated algorithms, and standard operating procedures as well as quality control measures. DM has limitations like low protein content and unpredictable composition of the other macronutrients, despite fortification frequently not meeting recommendations - both of them compromising growth. The first paragraph is devoted to COVID-19 and how it impacts processes of DM banking. The following paragraphs review aspects of \"pasteurization,\" \"safety audits/donor screening,\" and \"DM nutrient variability.\" In summary, (i) Holder pasteurization still is the most suitable procedure for milk banks, but high-pressure pasteurization or ultraviolet C irradiation conserve the unique properties of DM better and deserve more research to make it suitable for clinical routine. (ii) In regard to safety/screening, guidelines are valuable for safe DM bank operation, but they differ between legislations. There is a surprisingly high rate of non-disclosed donor smoking (0.3%, p > 0.05) and of adulteration of delivered DM (up to 2%, p < 0.05) not detected by standard donor screening procedures. Frequencies differ between remunerated and non-remunerated programs. (iii) Neonatal caregivers should be aware of unpredictable composition of DM. They should be trained on how these can be overcome to avoid negative impact on growth and long-term outcomes like (a) measuring and disclosing nutrient contents of delivered DM batches to customers, (b) implementing certain types of donor pooling to reduce the risk of macronutrient depleted DM, (c) additional supplementation using 0.3-0.5 g protein/100 mL seems to be reasonable, (d) adjusted fortification may help to improve growth, but is not efficient in all preterm infants, (e) target fortification seems to improve growth (and probably also neurodevelopmental index) compared to standard fortification, (f) more research and clinical studies are needed.","PeriodicalId":18986,"journal":{"name":"Nestle Nutrition Institute workshop series","volume":"76 1","pages":"57-71"},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76082742","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Summary on Optimizing Feeding, Nutrition and Growth on the NICU and after Discharge.","authors":"N. Embleton","doi":"10.1159/000519402","DOIUrl":"https://doi.org/10.1159/000519402","url":null,"abstract":"","PeriodicalId":18986,"journal":{"name":"Nestle Nutrition Institute workshop series","volume":"53 96 1","pages":"54-56"},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73597353","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
C. H. P. van den Akker, N. Embleton, M. Vermeulen, J. V. van Goudoever
Mother's own milk is universally recognized as the optimal source of nutrition for preterm infants, although most authorities agree a multi-nutrient fortifier must be added in order to support nutrient accretion at a rate comparable to in utero. Nevertheless, many preterm infants face a gap between achieved growth and what could have been achieved in utero. In this narrative review, we provide an overview on the macronutrient content in mother's own milk and donor milk and how this can be enhanced by the various available multi-nutrient fortifiers. We describe their general compositions and formulation, as well as several of their theoretical and practical advantages and drawbacks. In addition, differences between standardized fortification, or a more individualized approach like adjusted and targeted fortification are discussed. The optimal strategy however remains to be elucidated, and more experimental well-powered studies are therefore urgently needed. Until then, financial considerations and practical capabilities are likely to be the main drivers of local fortification strategies.
{"title":"Meeting Protein and Energy Requirements of Preterm Infants Receiving Human Milk.","authors":"C. H. P. van den Akker, N. Embleton, M. Vermeulen, J. V. van Goudoever","doi":"10.1159/000519397","DOIUrl":"https://doi.org/10.1159/000519397","url":null,"abstract":"Mother's own milk is universally recognized as the optimal source of nutrition for preterm infants, although most authorities agree a multi-nutrient fortifier must be added in order to support nutrient accretion at a rate comparable to in utero. Nevertheless, many preterm infants face a gap between achieved growth and what could have been achieved in utero. In this narrative review, we provide an overview on the macronutrient content in mother's own milk and donor milk and how this can be enhanced by the various available multi-nutrient fortifiers. We describe their general compositions and formulation, as well as several of their theoretical and practical advantages and drawbacks. In addition, differences between standardized fortification, or a more individualized approach like adjusted and targeted fortification are discussed. The optimal strategy however remains to be elucidated, and more experimental well-powered studies are therefore urgently needed. Until then, financial considerations and practical capabilities are likely to be the main drivers of local fortification strategies.","PeriodicalId":18986,"journal":{"name":"Nestle Nutrition Institute workshop series","volume":"476 1","pages":"72-85"},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78119616","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
F. Haschke, J. V. van Goudoever, N. Haiden, D. Grathwohl
For preterm and small-for-gestational age infants on enteral nutrition, the best solution is to add human milk fortifier (HMF) to human milk (HM) which is provided by the mother or a milk bank. HMF provides a means to add additional protein, energy, and micronutrients, while maintaining HM as the main source of nutrition. Because of their rapid increase of lean body mass, preterm infants have much higher protein requirements than term infants. Recommendations on protein requirements of preterm infants are available, but protein quality - i.e. the amino acid (AA) profile in HMFs has not been systematically assessed. Present guidelines for enteral nutrition recommend protein intakes around 4 g/kg body weight (BW) for preterm infants <1,500 g, an intake that is not achievable with unfortified HM intakes <200 mL/kg BW/day. It is generally assumed that the AA profile of HM is the best reference for the AA profile of HMF. We calculated advisable intakes of AAs for preterm infants between 400-2,500 g which are based on AA increments of the fetus. Corrections for absorption, inevitable losses, oxidation, and variation of AAs in HM were introduced. Our calculations indicate that extremely low birth weight (ELBW <1,000 g) and very low birth weight (VLBW <1,500 g) infants have substantially higher AA requirements than low birth weight (LBW) infants growing from 1,900 to 2,400 g. In ELBW infants, daily intakes of the different indispensable AAs (IAA) with 4 g of (term) HM protein/kg BW range between 59 and 125% of the respective advisable intakes. Intakes of 7 IAAs and 3 conditionally indispensable AAs (CIAA) are below advisable intakes. On the other hand, with 4 g HM protein per kg BW/day, the IAAs isoleucine and leucine and some dispensable AAs are already supplied in abundance. In VLBW infants, daily intakes of the IAA methionine and 3 CIAAs are still below the advisable intakes. In LBW infants (<2,000 g) receiving 3.5 g HM protein per kg BW daily intakes of 1 IAA and 3 CIAAs would be too low. Preterm infants should receive HMFs which provide adequate amounts of AAs which are needed for their rapid growth and development while avoiding excessive intakes. In particular, very high AA requirements of ELBW infants are a challenge. AA composition of present HMFs for preterm infants should be reconsidered: spiking HMF protein with the AAs which are presently undersupplied or providing targeted AA-based HMF are options to further improve the AA profile in fortifiers.
对于需要肠内营养的早产儿和小胎龄婴儿，最好的解决办法是在母乳(HM)中添加母乳强化剂(HMF)，母乳是由母亲或母乳银行提供的。HMF提供了一种增加额外蛋白质、能量和微量营养素的方法，同时保持HM作为主要的营养来源。由于他们的瘦体重迅速增加，早产儿对蛋白质的需求比足月婴儿高得多。关于早产儿蛋白质需求的建议是可用的，但蛋白质质量-即HMFs中的氨基酸(AA)谱尚未得到系统评估。目前的肠内营养指南建议，对于< 1500克的早产儿，蛋白质摄入量约为4克/千克体重(BW)，如果未强化的HM摄入量<200毫升/千克体重/天，则无法实现这一摄入量。一般认为HM的AA型是HMF AA型的最佳参考。我们根据胎儿的AA增量计算出400- 2500克之间的早产儿AA的适宜摄入量。介绍了HM中原子吸收、不可避免的损失、氧化和原子吸收变化的修正。我们的计算表明，极低出生体重(ELBW <1,000 g)和极低出生体重(VLBW <1,500 g)的婴儿比低出生体重(LBW)从1,900到2,400 g的婴儿对AA的需求要高得多。在低体重婴儿中，不同必需氨基酸(IAA)和4 g (term) HM蛋白的日摄入量在各自建议摄入量的59%至125%之间。7种必需氨基酸和3种条件必需氨基酸(CIAA)的摄入量低于建议摄入量。另一方面，在每kg体重/天4 g HM蛋白的条件下，氨基酸异亮氨酸和亮氨酸以及一些必需的氨基酸已经得到了充足的供应。VLBW婴儿每日摄入的IAA、蛋氨酸和3种ciaa仍低于建议摄入量。在低体重婴儿(< 2000克)中，每公斤体重每天摄入1 IAA和3 ciaa的3.5 g HM蛋白会过低。早产儿应该接受高分子量食物，以提供他们快速生长发育所需的足量的AAs，同时避免过量摄入。特别是，低体重婴儿的高AA需求是一个挑战。应重新考虑目前用于早产儿的HMF的AA组成:用目前供应不足的AA添加HMF蛋白或提供靶向的AA基HMF是进一步改善强化剂中AA谱的选择。
{"title":"Human Milk Fortifiers for Preterm Infants: Do We Offer the Best Amino Acid Mix?","authors":"F. Haschke, J. V. van Goudoever, N. Haiden, D. Grathwohl","doi":"10.1159/000519394","DOIUrl":"https://doi.org/10.1159/000519394","url":null,"abstract":"For preterm and small-for-gestational age infants on enteral nutrition, the best solution is to add human milk fortifier (HMF) to human milk (HM) which is provided by the mother or a milk bank. HMF provides a means to add additional protein, energy, and micronutrients, while maintaining HM as the main source of nutrition. Because of their rapid increase of lean body mass, preterm infants have much higher protein requirements than term infants. Recommendations on protein requirements of preterm infants are available, but protein quality - i.e. the amino acid (AA) profile in HMFs has not been systematically assessed. Present guidelines for enteral nutrition recommend protein intakes around 4 g/kg body weight (BW) for preterm infants <1,500 g, an intake that is not achievable with unfortified HM intakes <200 mL/kg BW/day. It is generally assumed that the AA profile of HM is the best reference for the AA profile of HMF. We calculated advisable intakes of AAs for preterm infants between 400-2,500 g which are based on AA increments of the fetus. Corrections for absorption, inevitable losses, oxidation, and variation of AAs in HM were introduced. Our calculations indicate that extremely low birth weight (ELBW <1,000 g) and very low birth weight (VLBW <1,500 g) infants have substantially higher AA requirements than low birth weight (LBW) infants growing from 1,900 to 2,400 g. In ELBW infants, daily intakes of the different indispensable AAs (IAA) with 4 g of (term) HM protein/kg BW range between 59 and 125% of the respective advisable intakes. Intakes of 7 IAAs and 3 conditionally indispensable AAs (CIAA) are below advisable intakes. On the other hand, with 4 g HM protein per kg BW/day, the IAAs isoleucine and leucine and some dispensable AAs are already supplied in abundance. In VLBW infants, daily intakes of the IAA methionine and 3 CIAAs are still below the advisable intakes. In LBW infants (<2,000 g) receiving 3.5 g HM protein per kg BW daily intakes of 1 IAA and 3 CIAAs would be too low. Preterm infants should receive HMFs which provide adequate amounts of AAs which are needed for their rapid growth and development while avoiding excessive intakes. In particular, very high AA requirements of ELBW infants are a challenge. AA composition of present HMFs for preterm infants should be reconsidered: spiking HMF protein with the AAs which are presently undersupplied or providing targeted AA-based HMF are options to further improve the AA profile in fortifiers.","PeriodicalId":18986,"journal":{"name":"Nestle Nutrition Institute workshop series","volume":"96 1","pages":"86-100"},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86718336","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Providing a human milk fortifier once the preterm infant has started to suckle at the breast can be challenging for the mother and might shorten duration of the breastfeeding period. Fortification is recommended up to term for the normal-growing infant and up to 3 months in growth-retarded infants. After hospital discharge, some mothers may not want to pump, fortify, and bottle-feed the fortifier-milk mixture any longer. They desire to breastfeed their infants directly from the breast, but unfortunately, fortification often interferes with direct breastfeeding. Cup feeding is the most researched fortification method and appears to be safe but cannot be applied during nursing. Another alternative is the supplemental nursing systems, but only a few low-quality studies investigated the method, which is difficult to handle and requires a lot of nursing experience. The use of a finger feeder to administer a fortifier to preterm infants is a new method that enables mothers to exclusively breastfeed their infants and meet their nutritional needs. Mothers reported easy preparation and handling of the fortifier. More than 67% of the infants accepted the device and fortifier application during nursing very well. However, the development of further methods to augment preterm infant nutrition that does not interfere with breastfeeding is of great interest. Future efforts to enable fortification during breastfeeding must be linked to the development of ready-to-use devices containing liquid human milk fortification mixtures.
{"title":"New Ways to Provide a Human Milk Fortifier during Breastfeeding.","authors":"N. Haiden, F. Haschke","doi":"10.1159/000519398","DOIUrl":"https://doi.org/10.1159/000519398","url":null,"abstract":"Providing a human milk fortifier once the preterm infant has started to suckle at the breast can be challenging for the mother and might shorten duration of the breastfeeding period. Fortification is recommended up to term for the normal-growing infant and up to 3 months in growth-retarded infants. After hospital discharge, some mothers may not want to pump, fortify, and bottle-feed the fortifier-milk mixture any longer. They desire to breastfeed their infants directly from the breast, but unfortunately, fortification often interferes with direct breastfeeding. Cup feeding is the most researched fortification method and appears to be safe but cannot be applied during nursing. Another alternative is the supplemental nursing systems, but only a few low-quality studies investigated the method, which is difficult to handle and requires a lot of nursing experience. The use of a finger feeder to administer a fortifier to preterm infants is a new method that enables mothers to exclusively breastfeed their infants and meet their nutritional needs. Mothers reported easy preparation and handling of the fortifier. More than 67% of the infants accepted the device and fortifier application during nursing very well. However, the development of further methods to augment preterm infant nutrition that does not interfere with breastfeeding is of great interest. Future efforts to enable fortification during breastfeeding must be linked to the development of ready-to-use devices containing liquid human milk fortification mixtures.","PeriodicalId":18986,"journal":{"name":"Nestle Nutrition Institute workshop series","volume":"IA-20 1","pages":"101-106"},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84603930","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Approaches to enteral feeding significantly preterm infants' impact short-term outcomes including survival, late-onset sepsis (LOS), and necrotizing enterocolitis (NEC), and neurodevelopmental and later health outcomes. Clinical practice and trial data are dominated by short-term outcomes (NEC and LOS) with limited longer-term outcomes. Strategies maximizing early maternal breast milk (MOM) exposure and duration of MOM use are key given global health benefits of MOM, but few feeding trials use these as outcomes. Current data support colostrum receipt, early introduction, and progression of volumes between 18 and 30 mL/kg/day, without adverse impact on NEC, LOS, or mortality. Little evidence supports choosing between route of gastric tube placement, bolus, or continuous feed delivery. Individual infants may have specific features that require individualized feed management, such as combinations of growth restriction, antenatal blood flow concerns, intensive supportive needs (including inotropes), and large open patent ductus arteriosus, currently poorly represented in feeding trials. Infant tolerance monitoring includes clinical observations (stooling, abdominal size, vomiting) but routine gastric aspiration appears unhelpful. Infants should be monitored biochemically, anthropometrically, and in the future through bedside microbiomics or metabolomics. Units and networks should audit and compare their rates of mortality, NEC, LOS, neurodevelopment, and growth achieved.
{"title":"Starting and Increasing Feeds, Milk Tolerance and Monitoring of Gut Health in Significantly Preterm Infants.","authors":"J. Berrington","doi":"10.1159/000519384","DOIUrl":"https://doi.org/10.1159/000519384","url":null,"abstract":"Approaches to enteral feeding significantly preterm infants' impact short-term outcomes including survival, late-onset sepsis (LOS), and necrotizing enterocolitis (NEC), and neurodevelopmental and later health outcomes. Clinical practice and trial data are dominated by short-term outcomes (NEC and LOS) with limited longer-term outcomes. Strategies maximizing early maternal breast milk (MOM) exposure and duration of MOM use are key given global health benefits of MOM, but few feeding trials use these as outcomes. Current data support colostrum receipt, early introduction, and progression of volumes between 18 and 30 mL/kg/day, without adverse impact on NEC, LOS, or mortality. Little evidence supports choosing between route of gastric tube placement, bolus, or continuous feed delivery. Individual infants may have specific features that require individualized feed management, such as combinations of growth restriction, antenatal blood flow concerns, intensive supportive needs (including inotropes), and large open patent ductus arteriosus, currently poorly represented in feeding trials. Infant tolerance monitoring includes clinical observations (stooling, abdominal size, vomiting) but routine gastric aspiration appears unhelpful. Infants should be monitored biochemically, anthropometrically, and in the future through bedside microbiomics or metabolomics. Units and networks should audit and compare their rates of mortality, NEC, LOS, neurodevelopment, and growth achieved.","PeriodicalId":18986,"journal":{"name":"Nestle Nutrition Institute workshop series","volume":"30 1","pages":"1-12"},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85789106","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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