Around 8% of babies are born prematurely in the UK1. Premature babies have very different nutritional requirements to full term infants as they need to attain the growth that would have occurred in utero, as well as achieve functional development2. Inspired by breastmilk, we are committed to delivering products and services to help preterm babies thrive through appropriate nutritional support.
The first 1,000 days from conception to toddlerhood is a crucial window of opportunity and meeting the nutritional needs of infants during this period will positively influence short and long-term health outcomes3,4.
In the UK, around 60,000 infants are born every year before 37 weeks’ gestation5, of which 10% have a birth weight of less than 1,000g6,7. This means they have very specific dietary requirements.
Preterm nutritional needs and challenges
Preterm infants will face a multitude of challenges including: respiratory complications, poor thermoregulation, problems with gastrointestinal (GI) tract, low body stores of many nutrients and other medical complications8.
The final trimester of pregnancy is particularly important for fetal development9,10. This is a time of extensive development of organs9,10, immune system9,10 and the establishment of nutrient stores11 so preterm infants must complete much of this development ex utero12.
Feeding preterm infants
2010 ESPGHAN guidelines established recommended intakes for all major nutrients2. The focus was on enteral intakes in stable, growing preterm infants from a weight of 1-1.8kg2.
Key ESPGHAN recommendations
Advantages of breastmilk
Breastmilk is the best source of nutrition for preterm infants and offers many significant benefits to both infant and mother. It provides13:
- Protection from infections
- An improved feeding tolerance
- A reduced risk of necrotising enterocolitis (NEC)
- Digestive enzymes
- Benefits for baby’s gastrointestinal (GI) tract
- Psychological benefits for mum
However, many preterm infants may have higher nutritional requirements than breastmilk alone can provide2,13. The table below highlights the protein requirements of a preterm infant by body weight as stated in the ESPGHAN recommendations2. It highlights the potential gap between the amount of protein needed and the amount of protein breastmilk can provide.
Protein recommendations by body weight
Also, the daily intake volume that the preterm infant can tolerate is often not enough to cover their increased nutritional needs15-17 as the graph below shows:
The differences between the nutrition requirements of a preterm infant and the nutrition provided in breastmilk highlight the requirement for additional supplementation in the form of either a human milk fortifier and/or a protein supplement.
Some of the key components of breastmilk, all of which prove beneficial to a preterm infant’s development, include:
- Prebiotic oligosaccharides (OS)
- Long-chain polyunsaturated fatty acids (LCPs)
The role of prebiotic oligosaccharides
Prebiotic OS are non-digestible oligosaccharides that occur naturally in breastmilk18. Upon ingestion, they serve a number of functions19-23:
They first pass through the stomach and small intestine. The prebiotic OS mixture is then metabolised to produce Short Chain Fatty Acids (SCFA) in the large intestine. SCFA promote a thicker mucous layer lining the intestine and also lower pH levels in the intestine.
The presence of prebiotic OS prevents harmful bacteria from attaching to the intestinal lining and entering the bloodstream. They also encourage the growth of friendly bacteria and feed the beneficial bifidobacteria in the gut.
The role of beta-palmitate
Dietary lipids, or fats, provide preterm infants with a large proportion of their energy, with essential fatty acids and lipid soluble vitamins13.
The structure of fats in breastmilk consists of a glycerol group with three fatty acids attached, called a triglyceride. When palmitic acid is in the beta (β) position, lipids are metabolized more efficiently by infants24. This provides several beneficial effects, including: better fat absorption, improved calcium absorption, easier digestion and softer stools24-28.
The role of long-chain polyunsaturated fatty acids
LCPs are important for the healthy development of an infant’s brain29,30, eyes31, and nervous system32.
For preterm infants, LCPs such as docosahexaenoic acid (DHA) and arachidonic acid (AA) are conditionally essential as the third trimester is a critical period for brain growth33-37.
The ability to make DHA and AA in the body is very limited in the first few months of life33-35. Preterm infants fed formulas without LCPs develop poor DHA & AA status38-42. Formula enrichment with the LCPs, DHA & AA is recommended for preterm and post discharge feeding2,13,15,16,43,44.
It is recognised that the preterm infant is particularly vulnerable and has different nutritional needs to the full term infant. Breastmilk is the best source of nutrition and provides significant advantages, including key ingredients such as prebiotics, milk fats and LCPs. However, in instances where breastmilk is not available or the production of breastmilk is not sufficient to meet the preterm infant’s specific requirements, supplementation is recommended.