Nutrition of Premature Infants After Discharge

Abstract

Abstract

Knowledge about  how to feed especially very preterm infants after hospital discharge are conflicting and scarce.  Limited evidence suggests that feeding ’preterm formula’  to preterm infants after hospital discharge may increase growth rates upto 18 months post term and  improve neurodevelopmental outcomes compared to termformulas and unfortified donor milk, however they do not produce neurodevelopmental outcomes better than fortified human milk.  On the other hand, one of the popular alternatives of postdischarge nutrition for preterm infants,  ’postdischarge formula’ feeding  is not supported by available evidence. This  again indicates  that maternal milk has unique properties that formulas need to mimic as closely as possible. The goal in nourishing preterm infants after discharge should be to maintainmaternal milk, minimize nutrient deficits, promptly address these deficits once identified, and avoid overnourishing once nutrient deficits have been corrected. To achieve these goals,  an individualized approach based on growth, quality of growth (lean body mass etc.), and selective nutrient deficiencies is  recommended over theuse of general guidelines.

Keywords

• preterm infant,nutrition,post-discharge

Taburculuk Sonrası Prematüre Beslenmesi

Öz

Öz

Taburculuk sonrasında özellikle ileri derecede preterm yenidoğanların nasıl  besleneceği ile ilgili bilgiler az sayıda ve tartışmalıdır. Sınırlı kanıtlar taburculuk sonrasında preterm yenidoğanların “preterm formülleri” ile beslenmesinin postterm 18 aya kadar büyüme hızını artırdığını ve term formüllerle ve desteklenmemiş donor sütle beslenenlerle karşılaştırıldığında nörogelişimsel sonuçları iyileştirdiğini göstermekteyse de, desteklenmiş anne sütünden daha iyi nörogelişimsel sonuçlara yol açmamaktadır. Taburculuk sonrası beslenmenin gözde seçeneklerinden biri olarak sunulan “taburculuk sonrası formülü” ile beslenme ile ilgili eldeki  son kanıtlar  ise bu amaçla kullanımını desteklememektedir.  Bu durum anne sütünün eşsiz yapısını birkez daha kanıtlamakta ve formüllerin mümkün olduğunca anne sütüne en fazla benzeyecek şekilde üretilmesi gereğini ortaya koymaktadır.  Taburculuk sonrası preterm yenidoğanın beslenmesinde hedef, anne sütünün idame ettirilmesi, besin eksikliklerinin en aza indirgenmesi, ve eksiklik saptandığında hızlıca düzeltilmesi ancak düzeltirken aşırı beslenmeye yol açılmaması olmalıdır. Bu hedeflere  ulaşmada genel rehberlerden ziyade büyümeyi , büyüme kalitesini (yağsız vücut kütlesi gibi) ve bazıbesin eksikliklerini temel alan bireysel yaklaşım önerilmektedir.

Anahtar Kelimeler

• preterm yenidoğan,beslenme,taburculuk-sonrası

References

1. Kaynaklar 1-American Academy of Pediatrics. Committee on Nutrition. Nut-ritional needs of preterm infants. In: Kleinman RE, editor. Pe-diatric nutrition handbook. 5th ed. Elk Grove Village, IL: Ame-rican Academy of Pediatrics; 2004. p. 23e54. 2-Embleton NE, Pang N, Cooke RJ. Postnatal malnutrition andgrowth retardation: an inevitable consequence of current re-commendations in preterm infants?. Pediatrics 2001;107:270–3. 3-Clark RH, Thomas P, Peabody J. Extrauterine growth res-triction remains a serious problem in prematurely born neo-nates. Pediatrics 2003;111:986–90. 4-Dusick AM, Poindexter BB, Ehrenkranz RA, Lemons JA.Growth failure in the preterm infant: can we catch up? SeminPerinatol 2003;27(4):302–10. 5-Lucas A, Bishop NJ, King FJ, et al: Randomised trial of nut-rition for preterm infants after discharge. Arch Dis Child 1992;67: 324–327. 6-Bracewell MA, Hennessy EM, Wolke D, Marlow N. The EPI-Cure study: growth and blood pressure at 6 years of age. fol-lowing extremely preterm birth. Arch Dis Child. Fetal & Neo-natal Ed 2008;93:F108–14. 7-Trebar B, Traunecker R, Selbmann HK, RankeMB. Growthduring the first two years predicts pre-school height inchildren born with very low birth weight (VLBW): results ofa study of 1,320 children in Germany. Pediatric Research2007;62:209–14. 8-Cooke RWI, Foulder-Hughes L. Growth impairment in the verypreterm and cognitive and motor performance at years. ArchDis Child 2003;88:482–7. 9-LeppanenM, Lapinleimu H, Lind A,Matomaki J, Lehtonen L,Haataja L, et al. Antenatal and postnatal growth and 5- yearcognitive outcome in very preterm infants. Pediatrics2014;133(1):63–70. 10-Fewtrell M. Early nutritional predictors of long-term bone he-alth in preterm infants. Curr Opin Clin Nutr Metab Care2011;14(3):297–301. 11-Barker DJP. The developmental origins of adult disease. J AmColl Nutr 2004;23:588Se95S. 12-Gluckman PD, Hanson MA, Mitchell MD. Developmental ori-gins of health and disease: reducing the burden of chronic di-sease in the next generation. Genome Med 2010;2:14. 13-Lapillonne A, Griffin IJ. Feeding preterm infants today for la-ter metabolic and cardiovascular outcomes. J Pediatr2013;162(3 Suppl):S7–16. 14-Bhatia J. Post-Discharge nutrition of preterm infants. J Pe-rinatol 2005; 25: S15–S16, 15-Adamkin DH. Postdischarge nutritional therapy. J Perinatol2006;26:S27–S30. 16-Griffin IJ, Cooke RJ. Nutrition of preterm infants after hos-pital discharge. JPGN 2007.45: S195-S203. 17-Cooke R. Nutrition of preterm infants after discharge. Ann NutrMetab 2011;58 (suppl):32–36. 18-Cooke RJ. Postnatal growth and development in the pretermand small for gestational age infant. Nestle Nutr WorkshopSer Pediatr Program 2010;65:85e98. 19-Agostoni C, Buonocore G, Carnielli VP et al. Enteral nutri-ent supply for preterm infants: commentary from the Europe-an Society of Paediatric Gastroenterology, Hepatology andNutrition Committee on Nutrition. J Pediatr Gastroenterol Nutr2010; 50: 85–91. 20-Türk Neonatoloji Derneği Preterm ve Hasta Term Bebeğin Bes-lenmesi Rehberi. Taburculuk Sonrası Beslenme. Eds. Kültür-say N, Bilgen H, Türkyılmaz C 2014 : s.39-46. 21-Domellöf M, Georgieff MK. Post-discharge iron requirementsof the preterm infant. J Pediatr 2015 ; 167(4 0): S31–S35. 22-Morgan JA, Young L, McCormick FM, McGuire W. Promo-ting growth for preterm infants following hospital discharge.Arch Dis Child Fetal Neonatal Ed 2012;97:F295e8. 23-O’Connor DL, Khan S, Weishuhn K, Vaughan J, Jefferies A,Campbell DM, et al. Growth and nutrient intakes of humanmilk-fed preterm infants provided with extra energy and nut-rients after hospital discharge. Pediatrics 2008;121:766e76. 24-Arslanoglu S, Moro GE, Ziegler EE, The Wapm Working Gro-up On Nutrition. Optimization of human milk fortification forpreterm infants:new concepts and recommendations. J Peri-nat Med 2010;38:233-8. 25-Moro GE, Arslanoglu S, Bertino E, Corvaglia L, Montiros-so R, Picaud JC, et al. Human milk in feeding premature in-fants: Consensus statement. JPGN 2015; 61, Supplement 26-Koo WW, Hockman EM. Posthospital discharge feeding forpreterm infants: effects of standard compared with enrichedmilk formula on growth, bone mass, and body composition.Am J Clin Nutr 2006;84:1357–64 27-Young L, Embleton ND, McGuireW. Nutrient-enriched formu-la versus standard formula for preterm infants following hos-pital discharge. Cochrane Database of Systematic Reviews2016, Issue 12. Art. No.: CD004696. 28-Hay WW, Hendrickson KC. Preterm formula use in the pre-term very low birth weight infant. Semin Fetal & Neona-tal Med 2016; 1-8.