Managing the Human-Milk-Fed, Preterm, VLBW Infant at NICU Discharge

Abstract

Preterm, very-low-birth-weight (VLBW) infants are at high nutritional risk because of poor nutrient stores at birth, digestive and neurodevelopmental immaturity, and increased risk of medical and surgical complications. Human milk (HM) is the preferred feeding for nearly all newborns. It is easily digested, well absorbed, and decreases the risk of infection. To meet the nutritional needs of small babies, however, HM requires fortification. HM fortification is the accepted norm during neonatal intensive care unit (NICU) hospitalization. This article reviews how to manage the human-milk-fed preterm VLBW infant at NICU discharge. Recent evidence suggests that HM alone after discharge may not replenish nutrient deficits accumulated during the hospital stay or sustain growth in the immediate follow-up period. Practitioners are challenged with devising nutritionally adequate diets that are practical and sustainable while preserving the HM supply and protecting the breastfeeding experience. We will review the available science; reveal pitfalls in common practices, including “the sprinkles dilemma”; and present several options for regimens that meet nutritional goals.