The arrival of a premature baby can be a traumatic experience, more so if the baby is unwell. Preterm babies are especially vulnerable to poor growth and developing various disorders since they are born with significantly insufficient nutrient stores. But nutritional intervention in preterm babies helps build their strength.
Usha Sharma, who was nearing the 28th week of her second pregnancy, was shocked to be told she needed a caesarean section in less than a month as her blood pressure was high. The baby was delivered at 28 weeks.The Sharmas had not expected their second baby to be premature and went through a lot of emotional stress over fears that the premature birth might put their baby at risk of developing mental and physical disabilities.
Not fully developed
When a baby is born too early his/her major organs are not fully developed and this may lead to various health problems. The condition becomes critical if the baby is born before 32 weeks. Since less time has been spent in utero (inside the uterus), the nutritional status has been invariably compromised. Often, preemies are born with depleted stores of key nutrients: proteins, zinc, iron, calcium, vitamin A, sugar and have no subcutaneous fat. A preterm baby grows faster in the weeks after birth and, therefore, needs higher amounts of energy and protein to meet its nutritional requirements.
Babies born with extreme low weight are more likely to experience high rates of mortality and morbidity. Preterm babies are at high risk of developing respiratory distress as their lungs are not fully formed. In-utero growth restriction can be associated with impaired neurodevelopment as well as vascular disease, diabetes and obesity in later life. They may continue to have short stature well into childhood and adolescence, and may have less than typical intellectual and developmental outcomes due in part to nutritional deficiencies.
The nutritional requirements of preemies differ, depending on the degree of prematurity, size, weight... Breast milk is the best choice for preterm infants as it bestows key nutrients essential for growth. Breastfeeding provides several beneficial elements including immunoglobulin molecules that help lower the risk of sepsis and necrotising enterocolitis and also facilitate optimal development of the nervous system.
Problem with swallowing
But preterm infants also have an impaired suck-swallow-breathe pattern and are not able to absorb sufficient milk to meet their nutritional requirements. The suck reflex develops at about 35 weeks post-conceptual age. In such cases, it becomes necessary to use human milk fortifiers or preterm formula. Fortification may help meet special nutritional needs of premature infants i.e. the need for nutrients like iron, zinc, protein, omega-3 fatty acids (DHA), key vitamins, phosprous etc.
It is important to remember that, unlike term babies, a premature baby may not cry when he is hungry. This can be put down to a host of reasons connected with incomplete development of body systems including the central nervous system. Establishing a feeding routine for pre-term infants is therefore of prime importance. It is advisable to give small but frequent feeds.
While starting solid foods, parents need to remember that swallowing properly may not come naturally to pre-term babies. It is generally recommended that pre-term babies be started on solid food six months after the original due date and not six months after they were born.
Doctors prefer monitoring a pre-term baby's growth for up to two years. This requires active participation from the parents. For instance, parents need to tell the doctor how active their baby is or when exactly he/she sat up or started crawling.
Preterm Problems
Preterm infants suffer from:
Depleted nutrient stores
Greater requirements for growth
Concomitant conditions, e.g. chronic lung disease
Immature gut and low enzyme levels
Poor sucking pattern
Improper temperature control
Optimal Nutrition
Protein: Certain amino acids essential for adequate growth of preterm include cystine, taurine, alanine and arginine
Fat: Essential fatty acids are needed for optimal brain development such as arachidonic (ARA), á-linolenic, eicosapentaenoic (EPA), and docosahexaenoic (DHA) acids
Carbohydrates: Ideal balance of carbohydrates is required for healthy intestinal flora and for reducing the risk of necrotising enterocolitis
Minerals: Ensure optimum absorption and bone mineralisation
The writer is a Delhi-based neonatologist.
