Human milk feeding and fortification of human milk for premature infants
- Richard J Schanler, MD
Richard J Schanler, MD
- Hofstra Northwell School of Medicine
Premature infants have greater nutritional needs to achieve optimal growth in the neonatal period than at any other time of their life. There are several reasons for this:
●Infants born at the beginning of the third trimester of pregnancy have lower nutrient stores because they missed the surge in nutrient deposition characteristic of the last trimester.
●Medical conditions including infection, respiratory disorders, hypoxia, acidosis, and surgery increase metabolic energy requirements and thus nutrient needs .
●Additional impediments to growth are physiologic immaturity of the gastrointestinal tract including decreased gastrointestinal motility and reduced intestinal enzyme activity, and therapies such as corticosteroids.
Nutritional support helps to correct growth restriction at birth and to achieve an appropriate rate of weight gain, which is almost twice that of a term infant [2,3]. Parenteral nutrition is necessary for infants whose immaturity or medical condition precludes enteral feeding.
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- ADVANTAGES OF HUMAN MILK
- Improved host defense
- - Protection against necrotizing enterocolitis
- LIMITATIONS OF HUMAN MILK
- Inadequate supply
- Volume restrictions
- Nutrient limitations
- STRATEGIES TO MEET NUTRITIONAL NEEDS
- Preterm formula versus donor milk
- - Source of donor milk
- - Our approach
- FORTIFICATION OF HUMAN MILK
- Effect on infection
- - Necrotizing enterocolitis
- Commercial fortifiers
- Duration of fortification
- SUMMARY AND RECOMMENDATIONS