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Nutritional Recommendations for the Late-Preterm Infant and the Preterm Infant after Hospital Discharge

https://doi.org/10.1016/j.jpeds.2012.11.058Get rights and content

Early nutritional support of preterm infants is critical to life-long health and well being. Numerous studies have demonstrated that preterm infants are at increased risk of mortality and morbidity, including disturbances in brain development. To date, much attention has focused on enhancing the nutritional support of very low and extremely low birth weight infants to improve survival and quality of life. In most countries, preterm infants are sent home before their expected date of term birth for economic or other reasons. It is debatable whether these newborns require special nutritional regimens or discharge formulas. Furthermore, guidelines that specify how to feed very preterm infants after hospital discharge are scarce and conflicting. On the other hand, the late-preterm infant presents a challenge to health care providers immediately after birth when decisions must be made about how and where to care for these newborns. Considering these infants as well babies may place them at a disadvantage. Late-preterm infants have unique and often-unrecognized medical vulnerabilities and nutritional needs that predispose them to greater rates of morbidity and hospital readmissions. Poor or inadequate feeding during hospitalization may be one of the main reasons why late-preterm infants have difficulty gaining weight right after birth. Providing optimal nutritional support to late premature infants may improve survival and quality of life as it does for very preterm infants. In this work, we present a review of the literature and provide separate recommendations for the care and feeding of late-preterm infants and very preterm infants after discharge. We identify gaps in current knowledge as well as priorities for future research.

Section snippets

Nutritional Requirements for the Late-Preterm Infant

A variety of terms have been used to describe preterm infants born at a number of different intervals between 32 and 36 weeks' gestation (ie, “late preterm,” “near term,” “marginally preterm,” “moderately preterm,” “minimally preterm,” and “mildly preterm”). Only the terms “moderately preterm” and “late preterm” are defined well and should be used. The term “late-preterm infants” describes infants born between 34.0 and <37.0 weeks' gestation, and “moderately preterm” describes infants born

Growth and Quality of Growth

Extrauterine growth retardation (EUGR) describes postnatal growth of preterm infants that is less than the expected growth of a fetus at the same postconceptional age. It is a major problem that occurs in 60%-100% of preterm births globally.24, 25, 26, 27, 28 EUGR has been defined at discharge as growth values <10th percentile or <−2 SD from the mean of intrauterine growth expectation. It has also been defined as a change in z-score of >−1 SD or >−2 SD from birth to discharge.29 The latter

How to Monitor the Postdischarge Infant

Accurate serial measurements of weight, length, and head circumference plotted precisely on validated growth charts facilitate early identification of potential nutritional or health problems after hospital discharge. To ensure accuracy, measurements should be made by trained personnel who use standardized techniques. Expensive equipment is not necessary.81

Recommendations for Preterm Infants after Hospital Discharge

Guidelines for all preterm newborn infants should be similar because postconceptional nutritional needs are very similar. Therefore, the recommendations below are appropriate for all groups of preterm infants, except where indicated otherwise.

Author Disclosures

All authors received an honorarium from Mead Johnson Nutrition for attendance, presentation, and manuscript preparation. All authors have participated to the review of the available data and to the writing of the manuscript.

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    Please see the Author Disclosures at the end of this article.

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