Nutritional support for preterm infants at the outpatient stage: how to maintain continuity? A review

Author:

Pershina Elena S.ORCID,Korotaeva Natalya V.ORCID,Ippolitova Liudmila I.ORCID

Abstract

Globally, 15 million babies are born prematurely each year. Improvements in intensive care methods and treatment approaches have significantly improved the survival rate of this vulnerable group of patients. Suctioning of these babies does not end when they are discharged from hospital, but continues on an outpatient basis. In modern practice, the term "catch-up growth" is used to mean compensatory acceleration of growth of the organism after a period of stunted growth, particularly as a result of a lack of nutrients. To assess catch-up growth in the outpatient phase, body weight, height and head circumference should be assessed weekly or every 2 weeks during the first 46 weeks after discharge and then according to an individual plan until the child reaches the parameters of full-term peers, making adjustments for postconceptual or adjusted age. Different scales can be used to assess the physical development of preterm infants, such as the Fenton scale or the Intergrowth 21st, each of which has advantages and disadvantages. Maintaining breastfeeding of premature babies after discharge from hospital should remain our goal because of the many advantages, but at the same time on purely breastfeeding a premature baby will not receive sufficient protein, energy and fatty acids. This is where the neonatologist and paediatrician alike come in handy with breast milk fortifiers, whose application in practice is much easier than it seems. According to the "Programme for the Optimisation of Infant Feeding in the First Year of Life in the Russian Federation", breast-milk fortification should be carried out tentatively until 4052 weeks of post-conceptional age (provided the catch-up parameters of 1025th centile have been reached). If the child is artificially fed, adapted prematurity formula (with a protein content of 2.0 to 2.2 mg/100ml) should be continued until reaching the 1025th centile, with caloric intake calculated on the basis of 130 kcal/kg with a subsequent reduction. Although premature infants are a very vulnerable group of patients and require a special approach from paediatricians, the seeming difficulties of enteral feeding are quickly resolved if simple algorithms and proven approaches are followed.

Publisher

Consilium Medicum

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