Is feeding premature babies different from feeding full-term babies? Both the choice of milk powder and breastfeeding are different!

Author: Meng Jingwen, deputy chief nurse, Peking University First Hospital

Reviewer: Zou Liying, Chief Physician, Beijing Obstetrics and Gynecology Hospital, Capital Medical University

Inadequate nutritional intake after birth of premature babies can lead to delayed growth and development, and neurocognitive development disorders. With proper feeding, balanced and adequate nutrient intake, and the absence of serious disease factors, most premature babies can catch up with infants of the same age within 1-2 years.

Feeding for premature babies is particularly important when they are just born. Whether it is breastfeeding or formula feeding, it is different from normal full-term babies.

1. What kind of milk powder should be chosen for premature babies?

Breastfeeding is the first choice for premature babies, but there are some special circumstances, such as the mother's physical condition making it impossible to breastfeed, or the amount of breast milk cannot meet the growth and development needs of the premature baby, and breast milk is not enough. At this time, premature formula milk should be selected as a substitute.

There are special varieties of premature baby formula. During hospitalization, the hospital's premature baby formula is generally used. It is mainly for premature babies with a gestational age of less than 34 weeks and a birth weight of less than 1,800 grams. The energy density of the milk powder is higher. For example, 100 ml of premature baby formula contains 81 calories, and the nutrients will be correspondingly higher.

For late premature babies, that is, premature babies with a gestational age of more than 34 weeks and a birth weight of more than 1,800 grams, or premature babies who are about to be discharged from the hospital, there is a kind of milk powder called premature baby post-discharge formula milk powder, also called transitional milk powder. Generally, 100 ml contains 71 calories.

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There is a transition process for the selection of premature infant formula, such as from in-hospital premature infant formula to premature infant formula after discharge, and then to regular full-term infant formula. During the follow-up after discharge, the doctor will evaluate the growth and development indicators, and if the development is qualified, it can be gradually switched to regular milk powder.

For premature babies with a large gestational age, they may have very few complications at birth and their nutritional status is not very poor, so they may be able to switch to breast milk in 3 months. For premature babies with a small gestational age, there are many complications after birth that affect their growth and development, and they can generally be switched to breast milk in 3-6 months.

2. What should we pay attention to when breastfeeding premature babies?

The protein content of breast milk is relatively sufficient in the first two weeks after delivery. As the amount of breast milk increases, the protein content will be slightly lower and cannot meet the needs of premature infants' early growth and development, because premature infants have to complete catch-up growth and have a very high demand for nutrients. Therefore, it is necessary to supplement breast milk with a preparation including protein, vitamins, minerals and trace elements, called breast milk fortifier. Breast milk fortifiers are generally powdered and extracted from cow's milk. They are safe and effective. Breast milk fortifiers must be used under the recommendation and guidance of a doctor. In the early days, they were generally used in hospitals.

The indications for the use of breast milk fortifiers are: first, birth weight less than 1800 grams; second, premature infants have slow growth and development after birth; third, although premature infants try very hard to complete catch-up growth, their growth and development lags behind other full-term newborns of the same age; fourth, premature infants suffer from special diseases, such as heart disease, and their fluid intake needs to be strictly limited. They cannot eat too much breast milk and are prone to nutrient deficiencies.

Premature infants in the above-mentioned situations are suitable for the use of breast milk fortifiers. Doctors will conduct individualized assessments to see if breast milk fortifiers are needed.

3. How to add breast milk fortifiers to premature babies when breastfeeding?

To use breast milk fortifiers, you need to express breast milk and then add the fortifier to the breast milk. When using breast milk fortifiers for the first time, you need to observe the premature baby's adaptation to breast milk fortifiers in the early stage. Generally, add 1 bag of fortifier to 50 ml of breast milk, which is equivalent to half fortification, and observe the intestinal tolerance for two or three days. If the tolerance is achieved, gradually switch to full fortification, usually adding 1 bag of breast milk fortifier to 25 ml of breast milk.

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After discharge from the hospital, if the premature baby has not reached the time to stop breast milk fortifier, the doctor will instruct on how to use breast milk fortifier after returning home.

Breast milk fortifiers will increase the osmotic pressure of breast milk and increase the burden on the intestines. They must be mixed strictly according to the instructions, and it is best to mix them before use. Breast milk with breast milk fortifiers should not be left indoors for more than two hours, as it will increase the osmotic pressure. Breast milk fortifiers should not be diluted with water before mixing into breast milk, but should be added directly to breast milk and stirred thoroughly before consumption.

How long to take breast milk fortifier depends on the growth and development of the premature baby, and requires individualized assessment. Premature babies need regular follow-up after discharge, and the doctor will provide guidance during the follow-up. Parents should follow the doctor's advice on when to stop taking breast milk fortifier. If the doctor determines that it is time to stop taking breast milk fortifier, the doctor will also guide parents on how to stop taking breast milk fortifier. There needs to be a gradual reduction process, and it cannot be stopped all at once.