By: Talking Nutrition Editors
World Prematurity Day, celebrated on 17 November, was established by the European Foundation for the Care of Newborn Infants (EFCNI) along with partnering European organizations to raise awareness of the challenges of preterm birth and how to manage these most effectively. Premature birth is a common challenge worldwide, with 1 in every 10 babies – or 15 million babies per year – born too early.2 While complications from premature birth are common5, advances in medical care and nutrition have improved the outcomes for preterm infants.6
Nutrition plays a critical role in supporting optimal growth and development of premature infants. Promising data suggest that nutrition during pregnancy also plays an important role in pregnancy outcomes, with certain nutrients associated with a reduced risk of premature birth.2,4,7,8
Women experience immense physiological changes during pregnancy, which support optimal growth and development of the fetus. Meeting the increased needs for key nutrients during pregnancy can be challenging, making pregnant women particularly vulnerable to micronutrient and other deficiencies during this critical period of time. Public health agencies such as the the World Health Organization endorse the use of multiple micronutrients supplements (MMS) as a solution for improving maternal nutrition. MMS, which include prenatal vitamin and mineral products can help moms bridge gaps in their usual diet. Included in these products are nutrients which have a positive impact on the duration of pregnancy.9 Omega-3 long chain polyunsaturated fatty acids, folate, vitamin D as well as other micronutrients are key during pregnancy, some of which are highlighted here.
Omega-3 long chain polyunsaturated fatty acids (Omega-3 LCPUFA)
Preterm infants – who are born before 37 weeks gestation – have higher nutrient requirements relative to full-term infants. The third trimester of pregnancy is a time of rapid nutrient accumulation and growth, and infants born during this time are vulnerable to nutrient deficiencies.1,24 At the same time, they often struggle to tolerate adequate volumes of enteral feedings required to deliver the nutrients they need.25 Suboptimal nutrition in the neonatal period leads to cumulative protein and energy deficits, which can affect short term growth trends, limit brain growth, and result in poor developmental outcomes.24,26
In a recent randomized, controlled trial that included mothers intending to provide human mik and delivering at <28 weeks gestation and their infants, mothers were randomized to receive supplemental DHA at either 200 mg/day or 1000 mg/day. DHA levels were measured in maternal breast milk and in both maternal and infant red blood cells (RBCs), and markers of inflammation were measured in both mothers and infants. Breast milk levels of DHA correlated to the supplemented amount, with greater levels seen in the group receiving 1000 mg/day. Additionally, decreases in inflammatory markers in infants were found regardless of maternal supplementation amount. The anti-inflammatory impact of DHA in premature infants may promote an environment more suitable to growth and development.27 Other data suggest that DHA may have a positive role in reducing the risk of the retinopathy of prematurity, one of the consequences of premature birth.9,28
Tailored nutrition support strategies help clinicians meet the nutrient requirements of premature infants and positively influence long-term neurodevelopmental outcomes. Strategies include early parenteral nutrition, ensuring protein requirements are met, providing sufficient LCPUFAs like DHA and ARA, and prioritizing human milk for enteral feedings.1,24,29 The superiority of human milk for premature infants has been well-established based on expert recommendations, as well as improved clinical outcomes in premature infants fed exclusive human milk diets.30-32 Human milk contains many protective enzymes, hormones, and bioactive and growth factors that play important roles in immune function and organ system development and maturation. Whenever possible, human milk – either mother’s own milk or donor milk – should be provided to all premature infants.30
Meeting the nutrient requirements of premature infants often necessitates a personalized approach, yet standards of care are also needed to guide clinical decisions and ensure evidence-based practices are being utilized. Nutritional care practices can vary widely between physicians and hospitals; as such, written standards and protocols are quite valuable in helping caregivers ensure optimum feeding practices – both in the hospital and at home. EFCNI helps to meet this need by providing multiple standards of care for optimizing nutrition
World Prematurity Day brings together parents, healthcare professionals, experts in neonatology, and scientists who have the common goal of improving the long-term health of infants born prematurely. These groups advocate for the best possible prevention, treatment, support, and care for preterm and newborn children through specific focus on both dietary and medical angles. World Prematurity Day is celebrated with national and local events, educational campaigns, marches, and a call to take action for moms and babies. Participants are asked to commit to helping address preterm birth and working towards improving outcomes for preterm babies and their families. For more information, visit www.efcni.org.
Join the World Prematurity Day movement and conversations online.
DSM prioritizes educating and building awareness around nutritional solutions to help reduce the risk of preterm birth and supports optimal nutrition for preterm and newborn care. For more information about how DSM supports infant nutrition, visit: https://www.dsm.com/markets/human-nutrition/en/early-life-nutrition.html
16 November 2019
7 min read
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