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Nutrition Guidelines For Low Birth Weight And Pre Term Babies

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It is a bit challenging on a parent’s part to decide on the adequate nutrition for preterm babies. Meeting their very high nutrient needs is difficult and fraught with risks related to the physiological limitations of preterm infants. The most important limitation is the immaturity of the interstitial tract. A proper knowledge of the challenges and remedial steps can help tackle the situation successfully.

Wednesday, March 8th, 2017

Reasons behind the lack of nutrition in pre-term babies.

Though the rate of growth is much higher in pre-term babies than in term babies, their nutrient stores are very little. Most foetal stores of nutrients are built up in the last trimester of pregnancy, which is the loss that premature babies suffer. Thus, they begin their lives in nutritionally compromised state.

Moreover, gut maturation is also inadequate in pre-term babies but they adapt really fast to extra-uterine nutrition. Due to low gut maturation, pre-term babies are mostly subjected to Total Parenteral Nutrition (TPN), or providing nutrients through intravenous drips. But, whenever possible, pre-term babies should be given mimimal enteral feeding. Feeding few drops of colostrums paints the gastro-intestinal wall with immunoglobulins  and can promote gut maturity. Such feedings also reduce the levels of bilirubin in blood, which is commonly seen in pre-term and LBW infants.

Nutritional Support For Pre-Term Babies.

Nutritional support of preterm infants occurs in 2 distinct phases. During the early phase the nutrients are predominantly provided by feeding tubes route. During the later phase, babies are provided nutrition without the use of tubes. When babies are provided with proper nutrition, they may show enhanced growth that makes up for the developmental loss during the early phase. The requirements for this enhanced growth are higher. And therefore, you should know what exactly to feed her to meet her nutritional needs.

Proteins: Protein requirement for pre-term babies are higher. Synthesis of some amino acids like cysteine and taurine does not take place properly in premature babies. Whey protein is rich in these amino acids, and moreover it is low in amino acids like tyrosine, which cannot be digested by premature babies, so is highly recommended for premature babies.

Fats: Pre-mature babies have low levels of pancreatic enzymes and bile salts, which are required for absorption and emulsification of fats. Due to lack of these enzymes, pre-term babies tend to develop fat mal-absorption and steatorrhoea ( fat in stools). Moreover the development of brain and eyes, that mostly occurs in the last trimester and postnatally, can also be compromised in such babies. Long chain PUFA like DHA are required for neuronal development at these stages. Breast milk contains sufficient amount of DHA and carnitine. Carnitine is required for transport of long chain fatty acids (LCFA). If required supplementation of breast milk with DHA, may also be prescribed to pre-term baby.

Carbohydrates: Lactose present in milk increases the absorption of calcium and magnesium and is also helpful in establishing favourable intestinal bacterial colony. Some pre-term babies may show signs of lactose intolerance initially due to immaturity of the gut.

Energy and Fluid: ESPGAN recommends 110-165 Kcal energy/ kg body wt/ day and 150-200 ml fluid/ kg body wt/ day. Though these levels need to be attained gradually over a period of few days, to prevent the risk of distresses.

Iron: Pre-term babies are susceptible to iron deficiency by the time they reach 6-12 weeks of age. So 2.5 mg iron/kg body wt/ day is recommended from 6-8 weeks of birth.

Vitamins: Pre-term babies have very low stores of vitamins, so they need to be fulfilled by supplementation.

Considering all the nutrient requirements of a pre-term and low birth weight infant, it has been found that the mother’s own pre-term milk is the most superior to all the types of milk. So, as early as possible, the pre-term babies should be given mother’s milk and it should be tried to get breastfeeding established as early as possible. Though, babies above 34 weeks of gestational life and weighing above 1.8 kg can be put to breast and they can start to suck efficiently. So, the earlier it happens, the better it is for the baby.

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