Intended for healthcare professionals

Clinical Review ABC of preterm birth

Feeding the preterm infant

BMJ 2004; 329 doi: (Published 18 November 2004) Cite this as: BMJ 2004;329:1227
  1. William McGuire,
  2. Ginny Henderson,
  3. Peter W Fowlie


    Providing appropriate nutrition for growth and development is a cornerstone of the care of preterm infants. Early postnatal nutrition during this critical period of brain growth may have a substantial impact on clinically important outcomes, including long term neurodevelopment.

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    Infants with intrauterine growth restriction lack subcutaneous fat and other nutrient stores

    Preterm infants, especially those who have been growth restricted in utero, have fewer nutrient reserves at birth than term infants. Additionally, preterm infants are subject to physiological and metabolic stresses that can affect their nutritional needs, such as respiratory distress or infection. An international consensus group has recommended nutritional requirements for preterm infants. These recommendations are based on data from intrauterine growth and nutrient balance studies and assume that the optimal rate of postnatal growth for preterm infants should be similar to that of normal fetuses of the same postconception age. In practice, however, these target levels of nutrient input are not always achieved and this may result in important nutritional deficits.

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    Nutritional requirements for preterm infants*

    Enteral feeding

    Well infants of gestational age > 34 weeks are usually able to coordinate sucking, swallowing, and breathing, and so establish breast or bottle feeding. In less mature infants, oral feeding may not be safe or possible because of neurological immaturity or respiratory compromise. In these infants milk can be given as a continuous infusion or as an intermittent bolus through a fine feeding catheter passed via the nose or the mouth to the stomach.

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    Infants can be fed using a gastric tube if they are unable to breast or bottle feed

    Necrotising enterocolitis

    A major concern with the introduction of enteral feeds (especially to very preterm, growth restricted, or sick infants) is that the additional physiological strain on the immature gastrointestinal tract may predispose to the development of necrotising enterocolitis. The risk of necrotising …

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