Feeding vulnerable infants

Several studies have shown that mother’s own milk is the best form of nutrition for term and especially sick, preterm, and low birthweight infants. Human milk contains many protective enzymes, hormones and growth factors that play important roles in gastrointestinal development and maturation. Depending on gestational age, vulnerable infants may benefit less from the transfer of antibodies across the placenta during the last period of pregnancy. However, they can still receive antibodies through feeding with mother’s own milk. The immunologic aspects are especially relevant for preterm infants who are at a higher risk for infections. Additional benefits are a reduced risk of respiratory infections, sepsis, and necrotizing enterocolitis in preterm infants fed with mother’s own milk.

Whenever mothers are not able to provide own breast milk, donor human milk is the next best option for preterm, sick or low birthweight infants. Established human milk banks are responsible for screening donors, collecting, testing, processing, storing, and distributing donated human milk, which is to be used under medical prescription. Unfortunately, there is not enough donor human milk to sufficiently supply all infants in need at the moment.

Preterm, sick, and low birthweight infants may need additional nutritional supplements, as the brain, lungs and kidneys are still developing and therefore need adequate nutrition. Fortification can be described as nutrient supplement to human milk in order to provide additional calories, proteins, minerals, vitamins and trace elements. It is usually based on bovine milk, and sometimes on donkey milk or human milk.

In some cases, it may not be possible to provide a sufficient amount of mother’s own or donor human milk. In these cases, specially designed preterm infant formulas, which are usually based on bovine milk, goat milk, or soymilk, can be used. These formulas are richer in calories, proteins and minerals than formula for babies born at term in order to meet their special needs in terms of optimal growth and development.

If mothers cannot provide enough breast milk, it can also be supplemented with donor human milk from an established human milk bank following certain safety guidelines, or with specially designed infant formula for preterm babies.

Enteral nutrition means feeding the baby by using a nasogastric (via nose to stomach) or orogastric (via mouth to stomach) tube. It can be initiated as soon as the gastrointestinal tract is mature. This solution is recommended for vulnerable infants as long as they cannot independently coordinate to drink, suck, swallow and breathe. During the first days of life, only very small amounts of milk are administered until the intestines get used to it.

Parenteral nutrition is a feeding therapy that provides nutrition through the veins (into the bloodstream) to babies who cannot (yet) be adequately fed by mouth or through a feeding tube. Many preterm babies need some parenteral nutrition during the first week of life because the amount of enteral nutrition that can be provided during the first days does not yet meet the nutritional needs.

Find more information on enteral and parenteral nutrition here.