Written By: Longjam Dineshwori | Updated : November 19, 2022 10:56 AM IST
The first four weeks of an infant's life (or the first 28 days after birth) are called the neonatal period and this time is extremely crucial for the child's survival and development. The neonatal period carries the highest risk of death, and most neonatal deaths are known to happen in the first week. Hence, extreme care should be taken during this period. India celebrates Newborn Care Week from 15th to 21st November every year. The annual event aims to make people aware of the importance of the newborn care to improve child survival and reduce neonatal deaths.
Preterm birth, complications during birth, severe infections and birth defects are the main causes of newborn deaths. Premature babies or preemies are babies who are born before 37 weeks of pregnancy are completed. Premature infants are at risk for serious health problems. Therefore, they require special attention. So, let's talk about the nutritional needs of premature babies.
Dr Manju Kumari, MD, DM (Neo), Associate Consultant (NICU), SRCC Children's Hospital, managed by Narayana Health, says, "Premature babies come to outside world before expected time. Nutritional deficit leads to growth retardation, poor behavioural and cognitive outcomes in these vulnerable babies. The goal of nutritional support in preterm infants is achieving a postnatal growth rate similar to that of a normal fetus at the same post conceptual age. They are supposed to catch up their term counterparts by 2 years age."
According to Dr Manju, premature newborns suffer from lack of many nutrients. She explains, "The nutrient transfer occurs from mother to baby inside womb. When a baby is born prematurely, they lack multiple nutrient reserves, due to lost opportunity of transfer of nutrients. Along with that the premature organ system poses additional stress. They have immature skin and renal system, which leads to more water and sodium loss and thus they have additional water requirement. They go through many illnesses due to immature organs. Many have respiratory distress, congenital heart disease, necrotising enterocolitis, blood infection etc. Acute illnesses and chronic consequences like bronchopulmonary dysplasia leads to additional nutritional requirements."
Besides the additional nutritional requirements for proper growth of premature babies, they also require addressing feeding issues.
Dr Manju says, "They are not mature enough for direct breastfeeding. Developmentally supportive therapy in the form of Kangaroo mother care and oro-motor stimulation helps in early breastfeeding establishment."
Elaborating on this, Dr Manju says:
Early aggressive nutrition policy is adopted for optimal physical and neurodevelopmental growth of premature newborns. Babies who are very small or for any other reason not able to tolerate full oral feeds are started on parenteral nutrition which provides glucose, lipids, amino acids and micronutrients through intravenous access.
As soon as possible babies are transitioned to enteral feed either orally or with gavage. To fulfill their additional energy, protein and mineral requirement mother's milk is fortified with human milk fortifier. Along with that it is recommended to regularly check sodium, calcium, phosphorus, hemoglobin levels. They are supplemented with vitamin D and iron regularly. After discharge, it is preferred to start calcium and phosphorus supplement also.
Fortified mother's milk is the first choice for feeding. If for any reason own mother's milk is not available, then in that case donor human milk or preterm formula milk is preferred in that order.
Additionally, premature babies need regular growth monitoring and developmental assessments after discharge to ensure good outcome.
