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130 4.4 Preterm Infants

Formula-fed infants do not usually require extra ✘
supplements as the nutrient-enriched post-discharge
formula is fortified with all nutrients. It is usually ✔
prescribed until 6 months after the infant’s expected
date of delivery or until adequate catch-up growth Figure 4.4.4 Safe positioning for weaning
has been achieved. However, the evidence for benefit pre-term infants
beyond three months after their expected date of
delivery is limited (Young et al. 2012). Activity 1
Calculate the fluid, energy and nutrient
Some neonatal units recommend that the sterile requirements of a preterm baby weighing
ready-to-feed formula should be used until 4 weeks 1.8 kg and being fed by a nasogastric tube.
corrected age to reduce the risk of food-borne Compare this to the nutrients provided in a
infections. After this infants can be switched onto the suitable volume of expressed breast milk and a
cheaper powdered formula. Preparation and storage nutrient-enriched post-discharge formula. The
recommendations for these formula milks are the compositional details of the formula milk can be
same as for standard formulas for term infants. found on the company website.
Activity 2
Weaning Preterm Infants If a baby is born at 27 weeks gestation,
between which post-EDD (expected date of
The time to begin weaning a preterm infant may be delivery) ages would you consider beginning
a clinical decision made by the paediatrician. weaning?
Preterm infants have high nutritional needs that
are unlikely to be satisfied from milk alone for the Acknowledgements
4–6 months after their estimated date of delivery. With thanks to Caroline King, Specialist Neonatal
Current recommendations are that weaning should Dietitian, Hammersmith Hospital, London, and
begin at an earlier post-conception age than for Karen Hayes, Neonatal Dietitian, Addenbrooke’s
term infants. It is usually between 5 and 8 months Hospital, Cambridge.
old – the age from the preterm infant’s actual birth
date and not based on their corrected age (King
2009, King and Aloysius 2009).

As the infant’s gut is being used for milk feeds
from an earlier gestational age, it matures earlier
and will have adapted to cope with solid foods.

Some preterm infants will not have good head
control when it is time to begin weaning and
parents need to be advised to make sure the head
and neck are well supported during feeding, as seen
in Figure 4.4.4.

Weaning should then progress as for term
babies, introducing new textures to give infants the
opportunity to learn to manage them in their
mouth. Preterm babies are more likely to have
feeding problems than term babies.