If the birth weight of the baby is less than 1000 gm, the baby will not have sucking reflex or be able to take anything orally. So we immediately start off with intravenous fluids. Parenteral nutrition is mandated for pre-term babies and is administered through the IV fluids that contain dextrose and carbide along amino acids that is proteins, and lipids. The current recommendation is 1.5 gm of amino acids within one hour of birth, which should be added to the total parenteral nutrition (TPN), and one 1 gm of lipids per kg of weight, which should be started on day one.
The above would be started after 48 hrs if the baby is above 1500 gm. In the case of such babies enteric feeding has to be started to stimulate the stomach, as the babies will not be able to suck. A nasogastric tube that goes down till the stomach is used to start giving minimal feeds. Such babies also require amino acids supplementation along with IV fluids while the stimulation of the stomach is continued. This process is called trophic feeding.
As the baby grows to 32 weeks the sucking reflex develops and the baby knows how to swallow. We then give the baby tube feeds along with a little-expressed breast milk through the spoon and once 32 weeks are complete and the baby has started swallowing we give the baby to the mother for breastfeeding.
For how long does a premature baby need to stay in the hospital?
For a premature baby born around 28 weeks of gestation, we keep the baby in utero that is in a condition that replicates the womb, until the full term has been reached and the baby can take full feeds on its own. The baby has to be kept warm and the nutrition that he or she would receive through the umbilical cord has to be supplemented. The lung function of the baby has to be fully developed before we can discharge the baby. It can take a week, or even a month or more. Till the time the baby cannot fully feed on its own the baby has to be kept under observation at the hospital.
Are the nutritional requirements of premature baby different from that of a full term baby?
The nutritional requirements of preterm babies are higher than the full term babies as they need to catch up on growth. For catch-up growth, the preterm babies need more nutrition and hence, the feeding pattern may be different from that of full-term babies.
Do preterm babies have to follow any special feeding pattern?
Preterm babies have additional nutritional requirements compared to full term babies. Though they should be breastfed till 6 months of age, breast milk by itself cannot meet the additional nutritional requirement. To supplement the deficiencies in breast milk, fortifiers are added to expressed breast milk. Fortifiers are given twice a day, and the standard dosage is 1-2gms of fortifier to 50 ml of expressed breast milk.
How is the growth of a preterm baby monitored?
The weight increase is a vital parameter of growth. A preterm baby should gain 10-15gms of weight every day. We check the weight on a daily basis and the mandated increase of weight signifies that the baby is getting sufficient nutrition.
Do preterm babies need special follow-up nutrition beyond 6 months of age?
The first two years of a baby’s life are very important and are called the golden years. After the baby is born we factor in the period of prematurity and that is called corrective gestational age. If a baby is born 4 weeks premature, we take the corrective age considering the 4 weeks prematurity till the baby completes 2 years of age. Breast milk does not have enough Vitamin D so that has to be supplemented by 400 international units of Vitamin D drops daily. Calcium and multivitamins may also be given to the baby. WHO advises that breast milk should be fortified with Vitamin A and iodine enriched salt. The post-natal growth of a baby is of utmost importance and there are any signs of nutritional deficiency, they need to address and corrected.