Nutrition for premature babies health

Premature babies require special nutrition and health care, as they are born with physical handicaps due to incomplete development and complicating medical and health conditions.

However, the advances made in health care and nutrition of premature babies have greatly reduced their mortality rate and increased the survival rate of smaller babies.

The handicaps of premature babies

Babies born before 37 weeks in womb or those whose birth weight is less than 2500 grams are termed premature. Babies born before 34 weeks have trouble coordinating suckling, swallowing and breathing reflexes. In premature and low birth weight (LBW) babies, their metabolic and gastrointestinal immaturity jeopardize achieving proper growth. The handicaps affecting nutrition and health of these babies include general weakness, lack of sucking and swallowing reflexes, poor digestion and absorption, greater nutrition requirements (which are deficient in mother's milk), compromised immune function and lack of coughing reflex.

Health and nutrition requirements of premature babies

These babies have greater health risks and require to be kept in neonatal intensive care unit (NICU). In NICU warmth and humidity are controlled to protect from environmental vagaries, to reduce energy expenditure, to maintain body temperature and to avoid body fluid loss. Constantly their nutrition and fluid status is monitored and regulated by parenteral and tube feeding till their bodies are mature enough for breast-feeding. In babies needing respiratory ventilation, total parenteral nutrition (TPN) is resorted to.
After required weight gain and growth, individualized feeding plan is given to be followed up at home.

Nutrition for premature babies

The intrauterine growth of fetus is the fastest in third trimester of pregnancy. Hence these babies, to catch up with growth, have greater requirements of nutrients when compared to full-term babies.
Considering the danger of regurgitation and inhaling fluids, nutrition as enteral feeding may have to be delayed or deferred for sometime.
These babies have poor digestion and absorption and moreover their antenatal storage is also poor.
Enteral nutrition is normally initiated by 48 hours after birth, feeding 1 ml/hr or less of mother's milk or formula feed by tube feeding. Enteral nutrition at this low rate enhances the development of the gastrointestinal tract.
The increment of the quantity of enteral feeding has to assessed considering various factors like lung development, cough reflex and weight stabilization and gain during TPN.
The feeds should be given slowly and in small quantities to reduce distension of stomach and also protect from developing necrotizing enterocolitis (NEC), a serious inflammatory bowel disease of babies.
When the babies have developed coordination between sucking, swallowing, coughing and breathing reflexes, to improve their health oral feeding can be started.
The milk produced by the mothers of the premature babies is frozen at -20⁰C and stored till the need arises.
Though mother's milk is the best nutrition for the health of normal full term babies, milk of mothers of premature babies is found to be inadequate and require fortification with commercial fortifiers.
Even the milk from full-term mother also shows insufficiency for these special needs.
Infant formula is modeled after the mature breast milk; it is found to be unsuitable for the special needs of the premature babies as it shows insufficiency in proteins, calcium and other minerals.
If the mother's milk is inadequate or cannot be used for specific reasons, special formula feeds made for premature babies are to be used.
Considering their special nutrition requirements minimum and maximum of components are arrived at.

Energy requirement for health

It is estimated that energy intakes in the range of 110 - 135 kcl/kg/day will be needed for the health of these babies.
Hence it is recommended that feed giving energy intake of 120 kcl/kg/day may be fed. Further it is recommended that the minimum and maximum energy density may be 67 kcl/100 ml and 94 kcl/100 ml.

Proteins for health and nutrition

The recommended minimum concentration of protein in the feed formulation is 2.5 g/100 kcl and the maximum allowable concentration of protein in infant formula is 3.6 g/100 kcl.
To arrive at the required proportions of amino acids, the amino acid concentrations of cord blood, plasma amino acid levels of rapidly growing premature babies and plasma levels of breast-fed normal babies were taken into consideration.
There is higher rate of protein turnover in premature babies when compared to neonates of normal health.
Babies fed above the higher limit of protein concentration do not show corresponding gains and actually show lower IQ. In instances of still higher concentrations mortality has occurred.

Carbohydrates for babies health

The minimum requirement of carbohydrate content in nutrition for health of premature babies is 9.6 g/100 kcl and the maximum requirement is 12.5 g/100 kcl.
The lactose component of the carbohydrate must be at least 40% to keep good health.

Fats for premature babies health

The requirement of fats in nutrition for premature babies is limited to optimal fatty acid composition necessary for function of growing tissues. Further there are essential fatty acids which human body cannot synthesize.
For good health, the minimum recommended fat nutrition in feed is 4.4 g/ 100 kcl and the maximum is 5.7 g/100 kcl.
Among the essential fatty acids the requirement of all-cis Linoleic Acid is 8% of the total fatty acids and the maximum content should not exceed 25% of total fatty acids.
For good health of tissues, α-Linolenic acid is required at a minimum of 1.75% and a maximum of 4% of the total fatty acids.
Cholesterol and trans-fatty acids should not be added in the feed formulations of premature babies, as they can affect their nutrition status.

Minerals for health

There are special mineral requirements for the premature babies for their well being and nutrition and these mineral components and their ratios are given below.
Calcium: More than 99% of calcium present in the body is bound to bone. The minimum Calcium required in nutrition of these babies is 123 g/ 100kcl and the maximum is 185 mg/100 kcl. The recommended minimum calcium to phosphorus ratio is 1.7:1 and the maximum is 2:1.
Phosphorus: The recommended minimum phosphorus in nutrition for the health of premature babies is 82 mg/ 100kcl and the maximum allowable is 109 mg/100 kcl.

Minerals	Minimum	Maximum
Sodium	39 mg/ 100 kcl	63 mg/100 kcl
Potassium	60 mg/100 kcl	160 mg/100 kcl
Chloride	60 mg/100 kcl	160 mg/100 kcl
Iron	1.7 mg/100 kcl	3 mg/100 kcl
Zinc	1.1 mg/100 kcl	1.5 mg/100 kcl
Copper	100 µg/100 kcal	250 µg/100 kcal
Magnesium	6.8 mg/100 kcal	17 mg/100 kcal
Selenium	1.8 µg/100 kcal	5.0 µg/100 kcal
Iodine	6 µg/100 kcal	35 µg/100 kcal
Manganese	6.3 µg/ 100 kcal	25 µg/ 100 kcal

Vitamin Requirements for health and nutrition of premature babies

Vitamins	Minimum	Maximum
vitamin A	204 µg RE (700 IU)/100 kcal	380 µg RE (1254 IU)/100 kcal
vitamin D	75 IU/100 kcal	270 IU/100 kcl
vitamin E	2 mg α-TE/100 kcal	8 mg α-TE/100 kcal
vitamin K	4 µg/100 kcal	25 µg/100 kcal
vitamin C	8.3 mg/100 kcal	37 mg/100 kcal
Folic acid	30 µg/100 kcal	45 µg/100 kcal
vitamin B6	30 µg/100 kcal	250 µg/100 kcal
Riboflavin	80 µg/100 kcal	620 µg/100 kcal

Mother's milk is the best and preferred nutrition for normal babies.
Fortified milk of mother is the best in cases of premature birth.
Normal milk formula is insufficient in nutrition for these premature babies.
In case of non-availability (or inability as the case of HIV mother) of mother's milk, feed with special feed formulations catering to the needs of premature babies are required.