Premature baby. Questions Feeding premature newborns

A premature baby, compared to a child born at term, is in greater need of energy substances. In the last weeks of the fetus’s stay in the mother’s womb, the child’s body actively accumulates nutrients.

A prematurely born child does not have such reserves. Premature babies have an increased need for higher fatty acids, which are necessary for normal brain development. The best nutrition for newborns is mother's milk, as it contains all the necessary elements for normal growth of the body, biologically active substances, immune factors, and hormones. It is well absorbed. If a premature baby is unable to actively suckle, you should feed him expressed milk. When feeding, follow all recommendations given by your doctor upon discharge from the hospital or maternity hospital.

Each baby is individual. The feeding regimen should be chosen not only based on its weight, size, age at which it was born, but also on its degree of maturity, strength of reflexes and other parameters.

Breast milk has unique properties. Recent studies have shown that it is a living tissue of the human body and contains living cells.

When feeding premature babies, certain difficulties may arise due to underdevelopment or complete absence of sucking and swallowing reflexes; small size of the stomach and slow evacuation of its contents; decreased intestinal motility; reduced content of essential enzymes (mainly lipotropic enzymes and lactose); limited supply of essential nutrients.

Feeding is also complicated by the contradiction between the high need of a premature baby for nutrients and the limited ability to accept and assimilate them.

Nutrients needed by a premature baby

A premature baby is born with a limited supply of nutrients. Thus, the specific gravity of adipose tissue in a newborn weighing 3500 g is 16%, in a newborn weighing 1500 g - only 3%, in a newborn weighing 800 g - 1%. In a fetus at 20 weeks, the amount of protein reserve is 15 g, and at 40 weeks - 500 g. During the third trimester of pregnancy, the child receives 75-80% of the total amount of calcium, phosphorus, iron, and copper.

In order to provide prematurely born children with the necessary amount of nutrients and energy, it is necessary to calculate nutrition daily using the calorie method. The energy requirement for a premature baby is: on the first day after birth - 25-30 kcal/kg, on the second day - 40 kcal/kg, on the third day - 50 kcal/kg, on the fourth day - 60 kcal/kg, on the fifth day day - 70 kcal/kg, on the tenth day - 100 kcal/kg, by the twelfth day this need increases to 110 kcal/kg, by the end of the first month of life - 135-140 kcal/kg. When artificially feeding, the calorie intake of a one-month-old baby should not exceed 130 kcal/kg.

When calculating the daily volume of milk, the child’s weight is multiplied by the caloric content of the diet and divided by the caloric content of milk (700 kcal/l). For example, with a child’s body weight of 2000 g, whose daily ration is 60 kcal/kg, he should receive the amount of milk calculated by the formula:

For premature babies weighing 1500 g at birth at the age of two months, the calorie intake should be reduced by 5 kcal/kg. In very premature infants weighing less than 1500 g, caloric intake is reduced only after the child reaches three months.

Calorie content is reduced gradually, over the course of three months bringing it to the norm accepted for children born at term (115 kcal/kg). In this case, the diet should be commensurate with the child’s condition.

Despite all the benefits of breast milk, it is not able to fully satisfy the premature baby’s need for elements such as calcium, phosphorus, magnesium, zinc and vitamins B2, B6, C, D, E, K, and folic acid. This is due to the low supply of these substances in premature infants at birth and the increased need for these elements.

Having determined the volume of milk by the number of calories your baby needs, you should calculate the amount of protein that the child will receive with a given diet. It should not exceed 4 g/kg per day.

On average, the daily protein requirement of premature infants is 2.5-3.8 g/kg per day. In the first half of life, a prematurely born child should consume about 6.5 g/kg of fat per day, in the second half of the year - 6 g/kg per day. The need for carbohydrates during the first year is 12-14 g/kg per day, for liquid in the first week of life when the child’s body weight is less than 1500 g - 90-140 ml/kg per day (taking into account the liquid contained in milk).

Premature babies are much more likely than full-term babies to be fed artificially. In this case, it is very important to choose the right formula for feeding.

It should be remembered that most formulas intended for artificial feeding of premature infants contain relatively low levels of iron (less than 1 mg/100 ml).

There are special formulas for premature and low birth weight babies that are slightly different from formulas for full term babies. Their composition fully satisfies the nutritional needs of such children. The amount of protein in them should be higher: 1.9-2.2 g per 100 ml. The fatty component of the mixture should contain higher polyunsaturated fatty acids, especially decosahexaenoic and arachidonic acids. These fatty acids are not able to be synthesized in the child’s gastrointestinal tract. In formulas for premature babies, the lactose content is reduced and a glucose polymer is present, which promotes the development of bifidum bacteria. Formulas for prematurely born babies must contain choline, inositol, L-carnitine, taurine.

Special formulas are given to premature babies until the child reaches a body weight of 3500-4000 g. After this, they can be transferred to formulas for children in the first six months, and after six months - to formulas for children after six months. If your child tolerates formula well, use it. It is recommended to feed the baby with formula from one manufacturer. This reduces the risk of food allergies and increases the efficiency of feeding. The volume and frequency of feedings are determined for each baby separately.

When artificially feeding a child, it is necessary to additionally drink boiled water between feedings. Start adding fruit juices, purees, cereals and other complementary foods to the diet of a premature baby at a later date compared to full-term babies, since his digestive system and enzymes mature later.

The main juice for feeding is apple, although pear, cherry, and blackcurrant juice are also allowed. It is better to refrain from feeding tomato, grape, and citrus juice for the first time. In the first year, strawberry, strawberry, and beetroot juices are not acceptable for a child, as they can cause allergies.

The criteria for correct feeding of a premature baby are the following indicators: physical development, increase in body weight, presence or absence of regurgitation after feeding, presence or absence of bloating, frequency and character of stool, blood test.

Timing and methods of feeding very premature babies

The first feeding is carried out within 2-3 hours from the moment of birth of a premature baby and no later than 6-8 hours, regardless of his maturity. A baby weighing more than 2000 g who arrives in satisfactory condition can be put to the breast within the first minutes after birth. However, if the slightest signs of fatigue appear in the child - such as shortness of breath, the formation of cyanosis of the nasolabial triangle - feeding should be limited. For an immature child, mother's milk is necessary to an even greater extent than for a mature one. Therefore, the doctor’s efforts in this case should be aimed at maintaining breastfeeding.

You should be careful about free feeding when the baby is fed on demand. Premature babies in most cases are not able to regulate the amount of milk they receive. In this regard, they are assigned a fixed feeding time. Children with a body weight of 1500-2000 g, the absence of cerebral circulation pathology of the second or third degree, breathing problems, etc., are given a trial bottle feeding. In severe cases, the child is fed through a tube.

Feeding very premature infants with a body weight of less than 1000 g and a gestational age of 25-28 weeks is of great difficulty. When feeding such children, it is necessary to combine enteral and parenteral nutrition. The predominance of one or the other depends on the condition of the baby. Thus, in children at risk for the development of necrotizing ulcerative enterocolitis, parenteral nutrition predominates. It is prescribed only to children with severe defects, anomalies of the gastrointestinal tract, in the pre- and postoperative periods. When the child’s condition stabilizes and there is a tendency to improve, a minimum amount of enteral nutrition should be carefully administered.

The composition of mother's milk includes macrophages, leukocytes, Ti B lymphocytes, as well as a variety of biologically active substances, including antimicrobial and antiviral (immunoglobulin A, lactoferrin, lysozyme, etc.), a large number of hormones and growth factors and at least 60 enzymes.

If the child tolerates breastfeeding well, he is given seven or eight meals a day (at intervals of 2.5-3 hours during the day and at 4-6 hours at night).

Sterilization and pasteurization of human milk leads to the loss of a number of valuable biological qualities. Enzymes are inactivated, the content of vitamins decreases, protective immune factors are limited, and partial denaturation of the protein and fat components of the product occurs.

If the child weighs less than 1500 g and has symptoms of depression of the central nervous system, premature infants are fed in portions 7-10 times a day through a nasogastric tube. For this purpose, a soft catheter is used. It is inserted through the nose to a length equal to the distance from the bridge of the nose to the xiphoid process of the sternum. After inserting the probe, its free end is immersed in water to ensure that the probe is positioned correctly. When inserted correctly, there are no air bubbles. After this, the probe is fixed with an adhesive tape on the child’s cheek. First, a small amount of water is injected through the probe, then milk (5% glucose solution) is injected into the syringe. The probe is connected to the syringe using an adapter and feeding begins. The tube is removed some time after feeding, after squeezing it. With enteral tube feeding, it is necessary to monitor the passage of milk from time to time. Before the next feeding, check the amount of milk remaining in the stomach. If it is small and amounts to more than 10% of the input, then the feeding volume should be kept unchanged. If, before feeding, more than 10% of the injected milk remains in the child’s stomach, the regimen and single amount of food should be changed.

Continuous tube feeding is indicated for children weighing less than 1200 g or larger children, but with impaired passage of milk through the gastrointestinal tract.

There are several methods of long-term tube feeding, when milk is introduced around the clock or supplied intermittently. It is most common to administer milk over three hours, one hour apart during the day and five hours apart at night. The initial rate of milk administration is 1.5-3 ml/kg per hour. After a week, it gradually increases to 7-9 ml/kg per hour. Using this method, very premature babies receive the greatest amount of nutrients. The functional activity of the gastrointestinal tract also improves, congestion decreases, and the frequency of regurgitation and breathing problems associated with feeding are reduced.

After the child’s condition improves and the sucking reflex is activated, he should gradually be transferred to bottle feeding, and then begin to be applied to the breast. In this case, it is good to use the “kangaroo” method, when the mother places the naked baby on her chest, placing him vertically in the hollow between the mammary glands. The child feels the warmth of the mother, with close contact with her he calms down, his sucking reflexes are stimulated. At the same time, the mother's milk production increases.

If it is impossible to feed the child enterally in the first days of his life, parenteral feeding is carried out. In this case, a 10% glucose solution is administered intravenously at a rate of 4-5 ml/kg per minute (6-8 l/kg per day). By controlling blood glucose levels, you can increase the concentration of glucose solutions. The maximum dose of glucose is 11-12 mg/kg per minute (16-18 g/kg per day). On the second day after birth, solutions of amino acids are administered at a dose of 0.5-1.0 g/kg per day with a gradual increase in dose to 3 g/kg per day. From the second or third day, fat emulsions begin to be administered at a dose of 0.5 g/kg per day, gradually increasing the dose to 2-2.5 g/kg per day. Such feeding is carried out for 20-24 hours in the absence of gross metabolic disorders. When the child's condition improves, minimal enteral administration of milk is prescribed using long-term tube feeding.

Premature babies require special and more careful care than babies of normal weight. A premature baby is a baby born before 37-38 weeks of pregnancy and weighing less than 2.5 kilograms. Such children are characterized by thin skin and reddish wrinkled skin, lethargy and decreased muscle tone, inactivity and slow weight gain.

Often, early children begin to master various skills and abilities later. Therefore, such babies may lag behind in development by 1.5-4 months. However, with proper care and nutrition, and regular monitoring by a doctor, the child will soon catch up with his peers. If you follow the recommendations, the baby’s condition will be closer to normal by the age of one year. In this article we will look at the rules of care and feeding of premature newborns.

Rules for caring for premature babies

  • Children born prematurely are often characterized by poorly developed swallowing and sucking reflexes, so in the first weeks of life the baby may be prescribed tube feeding;
  • After birth, the premature baby is not immediately put to the breast, but is examined and placed in an incubator with automatic oxygen supply and maintaining optimal conditions for the child’s life;
  • Try, because mother's milk is the best nutrition and medicine. It strengthens the immune system and promotes weight gain, gives strength and accelerates the development of the baby;
  • If feeding is still provided only through a tube or bottle, regularly offer the baby the breast to develop the swallowing reflex;
  • Create comfortable conditions for babies in the children's room. The appropriate room temperature for premature and low birth weight babies is 22-25 degrees Celsius;
  • You can bathe a baby weighing less than 1.5 kg only after two to three weeks from birth. In other cases, swimming is allowed already on the 7-10th day. In this case, the suitable water temperature is 38 degrees above zero, and the air temperature in the bathroom is at least +25°C;
  • You can start walking with your baby only in warm weather 1.5-2 weeks after birth. The first walk should be short and take no more than ten minutes. Gradually increase your time in the air to 1.5 hours. It is not recommended to walk with a premature baby in hot or cold weather;
  • The doctor draws up an individual vaccination schedule and makes a personal calculation of the nutrition of premature babies depending on the weight, height and developmental characteristics of the baby;
  • Massage brings invaluable benefits to the development of a low birth weight baby. More than half of these children begin to gain weight faster. In addition, this procedure strengthens muscles and immunity, promotes the development of reflexes and improves the child’s physical condition. However, it is important to have the massage performed by a professional;
  • Before starting a massage or gymnastics, be sure to consult your doctor! Massage can be introduced already in the second week of life, and special gymnastics after 1-1.5 months from the moment of birth;
  • If the baby weighs less than two kilograms, it is important to dress the child warmly. With a higher body weight, infants are dressed in the same way as children born at term. Read how to dress a newborn.

Features of nutrition of premature babies

The peculiarities of feeding premature babies are associated with the fact that such babies have a poorly developed digestive system, sucking and swallowing reflex. Under no circumstances should you overfeed your baby while trying to achieve the desired weight! This can seriously harm the digestive system and cause severe intoxication.

To monitor a newborn’s nutrition, it is recommended to regularly weigh the baby and carefully measure the amount of food. For convenience, you can keep a food diary for your premature baby by month. It is important to establish a comfortable feeding regimen and follow the recommendations.

Modern pediatricians advise introducing feeding for infants on demand, and not according to a schedule. However, this is quite difficult to do for premature babies, since such babies sleep most of the time and do not express the desire to eat. In this case, it is recommended to combine the on-demand and on-demand modes. It is important that there are no long gaps between feedings. But don’t force-feed your baby!

In addition to basic nutrition, the doctor may recommend including additional vitamins in the child’s diet. In the first three days of life, vitamins C and K are needed, after two to three weeks - vitamin D. In addition, it is important for a premature baby to take iron. These beneficial elements can be included in a special therapeutic diet or administered separately.

Norm and frequency of feedings

In the first two weeks of life, the daily food intake for a baby is calculated using Rommel’s formula. For every hundred grams of body weight, there are 10 ml of milk or formula, to which you need to add the number of days of the baby’s life.

For example, to determine the amount of nutrition for a one-week-old newborn weighing 2 kg, we use the following calculations: 10 ml + 7 (days of a child’s life) – 17 ml for every 100 grams. Thus, for 2000 g 17*20 and we get 340 ml.

Artificial feeding and formula milk

If a nursing mother for some reason cannot feed her baby breast milk, she needs to choose the right formula. This should be high-quality and suitable nutrition with the necessary set of vitamins and nutrients. When choosing a formula, it is important to take into account all the characteristics of the child, including premature birth, weight and height, age, reaction to certain components.

Choose specially adapted milk formulas for premature or low birth weight babies. Such compositions are distinguished by increased energy value and increased calorie content, which contributes to rapid weight gain. This saturates the child with energy and gives strength.

Adapted formulas for premature or low birth weight babies often contain calcium and phosphorus, which strengthens bones and teeth and stimulates growth and weight gain. In addition, the composition includes a high protein content, quickly digestible carbohydrates, various vitamins, macro- and microelements. The mixtures include nucleotides for normal digestion and the formation of healthy intestinal microflora, as well as polyunsaturated fatty acids for mental abilities and the full functioning of nerve cells.

Tube feeding

Feeding a premature baby through a tube is carried out if the baby was born before 33-34 weeks. The doctor prescribes this method of feeding in case of deep or extreme immaturity, when there is no sucking-swallowing reflex, in case of a critical condition of the child after birth and in case of abnormal development of the nasopharynx.

When feeding through a tube, it is important to maintain sterility. The installation of the device is carried out by professional doctors. As a rule, it lasts three days, after which it is replaced. When the probe is inserted, the baby is fed with heated milk or formula with a temperature of up to 40 degrees via a syringe. The process is carried out under the strict supervision of a doctor.

This method is fed until the child’s condition stabilizes. When the baby develops a sucking and swallowing reflex and gains weight, you can switch to normal nutrition. It is important that infants do not experience nausea and vomiting, excessive regurgitation and bloating. To determine the sucking-swallowing reflex, periodically put the baby to the breast or put a bottle with a nipple to the mouth.

Introduction of complementary feeding for premature babies

A premature baby needs to be fed a little differently than a full-term baby. In this case, the first complementary feeding begins at 5-6 months with 5% buckwheat porridge, and not with vegetable purees. Do not start feeding your baby if he is sick and unwell, during active teething, with severe colic and tummy problems!

The first porridges are prepared with water or vegetable broth in a ratio of 5 grams of cereal per 100 ml of water. Add a few drops of breast milk or formula to the dish, then gradually switch to 7,8 and 10% porridge. After buckwheat, rice is added and sunflower or olive oil is added to the porridge. It is not recommended to switch to milk porridge before eight months.

At the age of six months, include vegetable puree from cauliflower and broccoli, potatoes and zucchini. At the eighth month, the baby is given meat puree from rabbit and turkey, then chicken and mashed egg yolk are included.

At the age of eight months, complementary foods in the form of fruit and vegetable juices also begin. The main juice is apple, but the baby can also be given drinks from pears, cherries and black currants, and a little later carrot juice is introduced. By the ninth month, you can give baby cookies and vegetable soup.

The table below will tell you about the timing of introduction and volumes of food into complementary feeding for a premature baby.

Lure Age Portion volume
Dairy-free porridge (buckwheat and rice, later corn) 6 months
(zucchini, potatoes, cauliflower and broccoli) 6-7 months From 10 g and increase by year to 180-200 g
Fruit puree (Apples, pears, apricots) 7 months From 5 g and increase by year to 100 g
Vegetable oil (olive or sunflower) 7 months From 1 gram and by nine months increase to a teaspoon
Meat puree (rabbit, turkey, chicken) 7-8 months From 10 g and increase by ten months to 80 g
Butter 7-8 months From 1 g and by nine months increase to 5 g
Cottage cheese 7-8 months From 10 g and increase by nine months to 50 g
Fruit and vegetable juice (apple, pear, cherry) 8 months From 10 ml and increase by ten months to 80-100 ml
Egg yolk 8 months From ¼ and gradually increase to ½
Milk porridge (buckwheat, rice, corn, oatmeal) 8-9 months From 5-10 grams and increase by year to 180-200 grams
Kefir and yogurt 9-10 months From 10 ml and increase by year to 150-200 ml
Fish puree (pollock, hake) 9-10 months From 10 g and increase by year to 50-70 g

Introduce each new product gradually and carefully. For the first time, let the baby try no more than half a teaspoon, and then wait two days. If there are no negative consequences in the form of allergies, poisoning, stomach or stool upset, the product can be included in the child’s diet. General rules for introducing complementary foods for infants can be found at the link.

After the baby receives complementary foods, supplement him with breast milk. Do not stop breastfeeding until at least 8-9 months, but it is better to continue feeding along with the introduction of complementary foods until 1.5-2 years. This improves the absorption of new food and normalizes digestion, reducing the risk of poisoning and deterioration of stool. Milk continues to provide the necessary elements for the full development of the child, as it changes along with the baby’s growth and adapts to his needs.

Formulas for premature and low birth weight babies are classified as a separate group of formulas, since the need for nutrients and energy in such children is different compared to ordinary newborns. Premature babies are understood to be children born at 28-37 completed weeks of pregnancy, weighing 1000-2500 g, and whose height is 34-45 cm. Depending on the weight of the child, there are four degrees of prematurity, each of which is characterized by its own methods and feeding habits. Low birth weight babies are understood to be children born at term, but with a body weight of less than 2500 g. Breast milk will be the undisputed leader in health and nutritional value for such children. If breastfeeding is not possible, special formulas are used.

Features of the composition

Formulas for premature babies are usually marked with the prefix “PRE” in the name of the mixture. The exception is the HiPP PRE mixture, which is recommended for feeding ordinary children from birth. Abbott produces Similac Neoshur and Similac Special Care formulas for premature babies.

Formulas for premature babies are characterized by increased caloric content compared to standard formulas. The daily protein requirement is also higher. It has been established that the higher the degree of prematurity of a child, the more protein his body needs. Using regular adapted formulas instead of specialized formulas can lead to a slower increase in muscle mass by the child, while the proportion of fat tissue will increase. The result will be a lag in the rate and speed of growth.

International recommendations for protein consumption by such children during the day are 3-4 g/kg body weight. Larger amounts of protein lead to metabolic disorders. The composition of the protein component of the mixture is of no small importance - it should be predominantly whey proteins, since casein is poorly absorbed by premature babies, which leads to an imbalance of amino acids. In the dry mixtures PreNAN, Humana 0 NA, as well as in the liquid ready-made mixture PreNAN 0, partially hydrolyzed protein is used instead of regular protein, which increases its digestibility and reduces allergenicity.

Important! The high protein content in formulas for premature babies allows for high growth rates and rates.

The optimal amount of fat is 6-6.5 g/kg body weight per day. The fat component contains medium chain triglycerides, which can be absorbed by the body without the influence of the digestive enzyme lipase, the activity of which may be reduced due to the prematurity of the child. Also required for administration are arachidonic and docosahexaenoic fatty acids.

In addition to regular formulas for premature and low birth weight babies, Nestlé produces breast milk fortifier PreNAN FM85. It allows you to increase its nutritional and energy value. PreNAN FM85 can be used according to a standard dilution scheme or an individual one, if a preliminary analysis of the composition of breast milk was done, which made it possible to determine the dilution rate for a particular child.

How long can you feed formula for premature babies?

The duration of use of formulas for premature babies is determined by the amount of protein in the mixture. If the amount of protein does not exceed 2.2 g/100 ml of the mixture, it can be used until the child reaches a body weight of 2500 g as the only mixture.

The calorie content of the diet should not exceed 130 kcal/kg. After reaching the specified weight, the child begins to gradually give the usual one, but not completely displacing the specialized one, but maintaining it in the amount of 30% of the total amount of food for several more weeks or months. This feature leads to the need to control the child’s diet not only in terms of calories, but also in protein, so as not to overload the child’s body. The duration of such a combined diet is determined by the degree of prematurity of the child. Thus, in the nutrition of very premature infants, the use of a specialized formula can be maintained up to 6-9 months of age in the amount of 1-2 feedings per day.

The use of specialized formulas for premature infants up to 6 months in a small volume (1/3-1/4 daily volume) is especially important for very premature infants, as it allows them to provide them with all nutrients, accelerate growth and prevent the development of osteopenia (decreased bone density ).

List of formulas for premature babies weighing up to 1800 g
PreNAN
Nutrilon Pre

Enfamil Prematura
Similac Special Care

Frisopre

PreNAN 0

List of formulas for premature babies weighing over 1800 g
Nutrilak Pre
Nutrilon Pre 1

Similak Neoshur

Formulas for premature babies are divided into dry and liquid according to the degree of readiness for use. It is believed that liquid mixtures are the safest, since they are sterile and minimize the risk of bacterial microflora entering from the outside during the operations for their preparation. Thus, from the point of view of microbiological safety, it is better to use liquid formulas for premature infants.

Otherwise, the selection of formula is individual and is mainly determined by the degree of prematurity of the child.

In contact with

The peculiarities of feeding premature babies are associated, on the one hand, with the immaturity of the gastrointestinal tract and low enzymatic activity, and on the other hand, with an increased need for nutrients, vitamins and microelements, because the baby needs strength to grow and get stronger. The ability depends on the degree of its maturity.

Very premature babies weighing up to 1500 grams and those born at 29 cannot suck and swallow on their own, so they are fed through a tube. These babies usually begin to breastfeed or bottle feed by the end of the first month of life. Children weighing 1500-2000 grams (II degree of prematurity - 32-34 weeks) can independently receive nutrition from a bottle or suckle at the breast. But often such babies do not have enough strength to suckle, and they are initially bottle-fed with expressed milk or formula, and then gradually try to switch to exclusive breastfeeding. Babies with the first degree of prematurity, born at 35 and weighing 2000-2500 grams, are quite capable of breastfeeding and develop well. Since the acidity of gastric juice is reduced , slow intestinal perilstatics, dysbiosis, then during this period they need to be fed exclusively, they usually have the word Pre in their name. Studies of breast milk from mothers of premature babies showed that depending on the degree of prematurity, their milk changed composition. This milk has an increased content of proteins, which are so necessary for the increased growth of a baby, as a building material, an increased content of essential amino acids, a higher degree of fat content, the breakdown of which does not require additional energy costs. In addition, mother's milk contains prebiotic substances that promote the growth of beneficial intestinal microflora, antibodies to various infections to which premature babies are especially susceptible, and enzymes that improve milk absorption. The energy value of “premature” milk is higher than that of “full-term” milk. Therefore, a woman should make every effort to preserve milk and eventually establish full breastfeeding.

Although, with all the desire to feed, many women who have had premature birth experience hypogalactia, that is, a lack or absence of breast milk. That's why from the first days, the mother should express milk and try to let the baby suckle. Because of their weakness, babies often have difficulty breastfeeding. If you see that the baby is tired and has a blue appearance around his mouth, then stop feeding and supplement with expressed milk from a bottle. Usually, by the 2nd - 4th week, children become stronger and are already able to switch to pure breastfeeding. To avoid losing milk, be sure to express every 3 hours, including at night, and after each feeding.

To prevent aspiration, the first feeding of a premature baby is carried out 3-6 hours after birth with sterile water. Subsequently, the child begins to receive a 5% glucose solution and already from the 5th-6th feeding (premature children of the 1st-2nd degree of prematurity) he is transferred to breast milk and a special milk formula. Babies with severe prematurity are transferred to breast milk for only 18-36 hours. Children are fed every 3 hours; with more frequent feedings (every 2 hours), the amount of nutrition received is carefully calculated so as not to overload the baby’s immature gastrointestinal tract. With severe prematurity (IV degree), sick children receive continuous feeding through a tube, like an IV. If the baby regurgitates or for other reasons cannot receive nutrition through the mouth, then nutrient solutions are administered intravenously - parenteral nutrition.

If the baby cannot receive breast milk for any reason, then he is fed with a special formula, which does not change until it reaches a weight of 4-5 kg. This mixture has a balanced composition of proteins, fats and carbohydrates for premature babies, contains an increased amount of taurine for brain development, calcium and phosphorus necessary for the mineralization of the child’s skeleton and bones, vitamins and other microelements, prebiotics and probiotics to prevent the development of intestinal dysbiosis.

The amount of formula or breast milk is calculated based on the caloric needs of a small organism. On the first day, the child receives 5 ml of mixture (nutrient solution) per feeding, the amount increases to 15-20 ml by the 3rd day of life. Next, the diet is calculated based on the daily norm for premature babies of 130-140 kcal per 1 kg of weight (for full-term babies this figure is 115 kcal). The calorie content of breast milk is 70 kcal per 100 ml, and the formula is 80 kcal per 100 ml.

Premature babies are especially prone to rickets and anemia. Therefore, even if the baby is breastfed, he needs additional vitamin D in the form of special drops from the first month (from 2-3 weeks). Also, these babies have very poor iron reserves in the body, which are usually depleted by the 1st month. Breast milk does not contain enough iron for children, despite the fact that it is absorbed very well from it, so the doctor, after assessing the baby’s condition, may decide to take additional iron-containing medications.

The first complementary foods for premature babies are usually introduced earlier at 4-4.5 months. To prevent the development of anemia and rickets, premature babies are given fruit and vegetable juices, purees, meat, and yolks earlier than full-term babies. Complementary feeding in the form of porridge is also important for a premature baby, as it helps him quickly gain the weight required for his age. Monitoring the effectiveness of feeding a premature baby and the state of his health should only be carried out by a doctor, who will, depending on the child, change or supplement the diet.

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Kazakova Lilia 12/07/2011 at 18:33

Pediatrician, lactation consultant

It is especially important to feed premature babies with mother's milk - it contains all the necessary substances that meet the baby's needs. Feeding a premature baby has its own characteristics - the digestive system of such children is not yet sufficiently developed, and the sucking reflex may be weak - so they need to be fed more often, in small portions. You may have to resort to supplementary feeding and special feeding methods. If breastfeeding is impossible for some reason, the doctor will recommend a special milk formula for premature babies.

How to position the baby correctly at the breast?

There are feeding positions that take into account the characteristics of premature babies. One of the most effective positions for application is “from under the arm”. This position provides good support for the baby's shoulders and neck, helping him to latch onto the nipple more comfortably. Due to poor regulation of breathing and swallowing, as well as decreased muscle tone, premature babies often swallow too much air. To avoid this, it is recommended that a woman lean back during feeding so that the baby lies on top of her chest: this position will reduce the pressure of the milk and it will be easier for the baby to swallow it.

How to help your baby keep the nipple in his mouth?

Premature babies often have difficulty keeping the nipple in their mouth because they have not yet developed the ridges on the palate and the fatty pads of the cheeks. In such cases, the mother, putting the baby to the breast, can support his cheeks with her thumb and forefinger, put her middle finger under her chin, and hold her breast with her little and ring fingers.

How much should a premature baby eat at one feeding?

If the baby weighs more than 2500 g, the total amount of food per day is determined at the rate of 150 ml of milk or formula per kilogram of weight. If the child is bottle-fed, the resulting amount is divided into eight feedings (every three hours). A child weighing less than 2500 g at birth should receive 60 ml of milk on the first day, then the total volume increases by 20 ml per kilogram of weight daily until the daily portion is 200 ml. The following formulas are also used: daily feeding volume = (n+10) for every 100 g of body weight at birth (n-days of life); or one-time feeding volume = 3 x m x n, (m-birth weight in kg). It should be taken into account that adjustments are needed for the individual needs of the child.

How many times a day should a premature baby be fed?

The number of feedings of the baby depends on his weight and general condition, as well as on the type of feeding (breast or artificial). With artificial feeding, premature babies can have up to seven to eight feedings per day, with a six-hour night break. With extreme prematurity, the number of feedings can be increased to ten. When the baby weighs 3.5–4 kg, he can switch to six feedings a day. The mother needs to remember that such a baby may have difficulty sucking, and during feeding he may take breaks for a few minutes to rest. If the mother is breastfeeding, then she needs to combine regular and “on demand” feeding, avoiding long breaks between feedings.

How to choose formula for premature babies?

Most manufacturers have in their arsenal special formulas for premature and low birth weight babies. However, before choosing one of them, you should consult your pediatrician. If the child in the maternity hospital has already been supplemented with some kind of formula, and he reacted positively to it, it is worth focusing on it.

How does a premature baby gain weight?

Any positive dynamics indicate that everything is fine with the child. Mom should be wary of weight loss or prolonged stagnation (lack of weight gain).

Is it necessary to give extra food to a premature baby?

If the baby is fully breastfed, there is no need to supplement him. If we are talking about artificial or mixed feeding, then he can be given clean water from a spoon or pipette. Many modern adapted mixtures may not require additional fluid administration.

Does my child need additional vitamins and minerals?

It is believed that premature babies need additional vitamins, especially when bottle-fed. In the first three days of life, premature babies are prescribed vitamin K and vitamin C. Two to three weeks after birth, additional vitamin D is given to prevent rickets. To prevent anemia, a premature baby also needs iron (its supply is formed precisely at the end of pregnancy, and the more premature the child is, the less iron it has).

Does a nursing mother of a premature baby need to take vitamins?

Apart from the vitamin complex prescribed by the doctor, no other medications are required. A normal balanced diet is quite enough for a nursing mother.

What are the features of breastfeeding premature babies?

It is better to put the baby to the breast in the delivery room, and immediately express the first drops of colostrum into his mouth. However, this can be difficult - premature babies often require intensive care or resuscitation immediately after birth. But even in this case, it is advisable to try to put the baby to the breast as soon as possible or give colostrum through a feeding tube. As soon as the baby gets stronger and is transferred from the intensive care unit to a regular ward, you can begin to put him to the breast regularly - this will help the rapid formation of the sucking reflex, which is less developed in premature babies than in those born at term. Premature babies are weakened and may not have enough strength to suck. Weak babies born at low birth weight or less than 32 weeks' gestational age are nursed using a nasogastric tube. When the baby is strong enough, he can be put to the breast more often: this way he will have more opportunities to learn to latch onto the nipple correctly. You can feed the baby from a bottle, and if the sucking reflex is weak, from a special soft spoon, cup, syringe without a needle or a Habermann sippy cup, as well as using the SNS system (a capillary coming from a bottle with expressed milk or formula, it is placed in the baby’s mouth along with the nipple).

Should a premature baby be fed on demand?

It is important to remember that feeding a premature baby “on demand” usually does not work: such children hardly express the desire to eat and sleep a lot. The mother of a newborn needs to combine scheduled feeding and response to “demand”, and make sure that there are no long gaps between feedings. Most likely, additional pumping will be needed: the baby may rarely attach to the breast and suck weakly, so even with frequent feedings, milk production will not be sufficiently stimulated. Regular pumping will increase lactation and allow you to supplement your baby with breast milk.

 

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