A preterm baby, as the name suggests, is one that is born before the full term of pregnancy — that is nine months. These babies need extra care and attention, because their development outside of the womb depends on it. Dr Sreenath Manikanti, senior consultant neonatologist, Kauvery Hospital, Electronic City, Bengaluru, says abnormal neurodevelopment is one of the major concerns in preterm survivors.
“Inadequate early postnatal nutrition appears to result in abnormal neurodevelopment. Provision of good nutrition becomes vital. Inadequate nutrients have been shown to cause short stature, growth failure, neuronal deficits and poor behavioural and cognitive outcomes in these vulnerable babies,” he says, adding that premature babies are deprived of the rich nutrition they get from their mother’s placenta when they are born early.
According to Dr Manikanti, preterm babies born before 32 weeks are unable to take mother’s feed directly. They often have medical conditions that increase their metabolic energy requirements, such as respiratory distress, hemodynamic instability, acidosis, sepsis etc. Most require specialised nutrition in the form of Total Parenteral Nutrition (TPN) where proteins, lipids, glucose, microelements and vitamins are given via central lines.
“Initiation of oral feeds early with expressed mother’s first milk (colostrum) within 1 hour of birth plays a significant role in helping these babies to progress to full feeds early and avoiding infections associated with long term parenteral nutrition. Until these babies develop suck and swallow reflexes to take mother’s feed directly, they are fed with Expressed Breast Milk (EBM) via a feeding tube in the NICU,” the doctor explains.
* Kangaroo mother’s care, oral motor stimulation and offering non-nutritive sucking (offering empty breast to suck) play an important role.
* Until the baby starts sucking, mothers are encouraged to pump their breasts every few hours to keep up the milk supply. In the first few days, if the mother is not able to provide enough EBM, babies are given pasteurized donor breast milk, mostly collected from mothers of healthy term babies expressing after a breast feed, less often from mothers of babies who have died or rarely in mothers whose babies are in the neonatal unit and have expressed milk in excess of requirement.
* Donor milk obtained from term babies is less nutrient rich (especially protein). Pasteurisation reduces the immune factors. In the absence of mother’s own milk (MOM), donor milk is beneficial in reducing complications such as of NEC (a severe form of gut infection) and improving long term outcomes like cognition, bone mineral content and cardiovascular health.
* Breast milk alone may not be sufficient to meet nutritional needs. EBM and donor milk can be supplemented with breast milk fortifiers to add extra calories, protein, minerals and vitamins.
* Once preterm babies reach 32 weeks, they can be assessed for sucking and swallowing, if direct breastfeeds and palladia /spoon feeds can be initiated.
Keep in mind
The doctor cautions these premature babies need regular growth monitoring and developmental assessments after discharge.
– Prevention of osteopenia of prematurity — A metabolic bone disease of premature infants as a result of inadequate calcium, phosphorus and vitamin D. It can be prevented with early supplementation of vitamin D, and optimising calcium and phosphorus.
– Prevention of anemia — Preterm babies are prone to anemia in view of low iron stores, erythropoietin and frequent blood samples, which are required to monitor parameters. It can be corrected with iron and erythropoietin supplementation and packed red cell transfusions, if required.
– Zinc and vitamin supplementation — Preterm babies need zinc and vitamin supplementation when they reach full feed.