Newborns fall to the ground, adding to the joy of the family, but there is a type of baby that needs parents to spend more energy than ordinary babies after being discharged from the hospital, that is, premature babies. Premature babies due to the in the womb is not fully developed, "forced" early birth, resulting in their growth and development process is more bumpy than the term baby, discharged home also need more careful care, the following look at the premature baby after discharge what problems need to pay attention to it ~
What exactly is eaten for feeding premature babies? How to eat?
First of all, the feeding of premature babies must meet the needs of growth and development, moderate feeding, and prevent nutritional deficiencies and overnutrition. Early catch-up growth after discharge from hospital plays a vital role in height, weight, and neurodevelopment, and if missed, it is difficult to compensate later. In particular, early and sufficient protein supply is crucial for its growth catch-up, body composition structure, and long-term physical and intellectual development.
In terms of feeding methods, breastfeeding is preferred, and the breast milk of premature mothers contains a variety of nutrients that are more adequate than the breast milk of term infants, and breast milk is easier to digest and absorb, and also contains many active substances such as immune factors, which can help improve the immunity of premature infants. Therefore, mothers should believe that their milk is best for their children and should let their children breastfeed as much as possible. This is followed by mixed feeding and artificial feeding.
After discharge, doctors develop nutritional regimens based on different circumstances, such as breast milk plus booster for less gestational-age infants with adequate breast milk, and formula for preterm infants with insufficient breast milk or non-breastfeeding after discharge, which is fed to a corrected gestational age of 3 to 6 months [1]. Breastfeed as much as possible for gestational age. Fortification time is 3-6 months.
Is there anything to watch out for in breastfeeding?
For preterm infants with a gestational age of < 34 weeks or a birth weight of < 2000 g or at risk of malnutrition, exclusive breastfeeding does not meet their protein and multi-nutrient needs, resulting in slower growth. Breast milk provides only 1/3 of the preterm baby's energy needs and a fraction of the nutrients. In addition, the calcium and phosphorus content in breast milk is low, and the lack of these minerals will stimulate osteoclasts to release bone calcium to maintain normal serum calcium concentrations, resulting in bone dysplasia in premature infants and increasing the risk of metabolic bone disease. Both the European Society of Pediatric Gastrointestinal Nutrition and the American Association of Pediatricians recommend that breastfed low-birth-weight premature infants need to use breast milk fortifications containing proteins, minerals and vitamins to meet their rapidly growing nutritional needs. The Chinese Recommendations for Feeding Preterm/LBW Infants recommends adding time after preterm infants tolerate 100 ml (kg.d) of breastfeeding [2].
If it is artificial feeding, how is formula applied?
For various reasons, premature babies can not achieve breastfeeding, can only choose formula, can be in accordance with the Chinese "preterm, low birth weight after discharge feeding recommendations", give post-discharge premature infants intensive nutrition formula to the corrected age of 3-6 months, some can be up to 1 year old, to help premature babies complete catch-up growth. Preterm infant formula usually contains higher energy, protein, long-chain polyunsaturated fatty acids, minerals and micronutrients than ordinary formula, but it meets the needs of the baby's growth and development, and will not lead to excessive and rapid weight growth of premature infants, adversely affecting long-term health, such as increasing the risk of adult hypertension, cardiovascular disease, type 2 diabetes and so on.
Although preterm formula retains many of the advantages of breast milk, makes protein, sugar, fat and other nutrients easy to digest and absorb, and appropriately increases calories, strengthens a variety of vitamins and minerals, can supplement the lack of breast milk for the nutritional needs of preterm infants, but premature formula lacks many growth factors, enzymes and IgA and other active substances in breast milk, so it is recommended to follow the above principles to choose a nutritional program suitable for your premature baby
Other issues
After the birth of the premature baby, in addition to paying attention to the total energy and three major production capacity nutrients, it is also necessary to pay attention to the supplementation of vitamins and minerals.
1. Vitamin D: Vitamin D deficiency increases the risk of asthma and allergic diseases. For preterm infants, 800 IU/day is recommended for up to three months and 400 IU/day after three months [3].
2. Prevention of anemia: There are many causes of anemia, mainly due to the lack of iron, folic acid and other nutrients. In particular, iron deficiency in preterm infants will affect the development of the baby's nervous system, if it is anemia in preterm infants, continue to supplement iron with 2mg/kg/day after discharge until the corrective age is 12 months old. If breast milk fortifiers, iron-fortified formulas, or other iron-rich foods are used, reduce iron supplementation as appropriate [4]. It is recommended that mothers need to pay attention to supplementing nutrients during pregnancy, especially iron supplementation.
When the baby is 4 to 6 months old and begins to add complementary foods, it is preferable to strengthen iron rice flour, continue to breastfeed or formula feeding, puree, and paste foods as fine, soft and rotten as possible, participate in the eating process, gradually develop good eating habits, and avoid nutrient deficiencies.
In addition, after discharge, mothers can consult the nutrition department and pediatric nurse, who will develop an individual nutrition plan and feeding plan according to the baby's nutritional risk assessment. Bao Mom and family members should cooperate with the doctor to implement a scientific parenting plan, communicate with the doctor in time when encountering problems, and adjust the plan. It should be emphasized that mothers insist on breastfeeding at least 6 months of age, especially advocating kangaroo care mode, recommending that babies and parents have more skin contact, and establishing a lactation record sheet to record the number of breastfeeding, the color, nature and amount of baby's urine and feces, and detect weight on demand to better understand the baby's growth and development.
bibliography:
1. Editorial Board of Chinese Journal of Pediatrics. Post-discharge feeding recommendations for preterm and low birth weight infants[J].Chinese Journal of Pediatrics,2016,54(1):6-12.
2. Wang Yan,Li Xiaoxuan. Nutritional management after discharge of preterm infants[J]. Clinical Medicine, 2018,(38)8: 58-60.
3. Ehlayel M S,Bener A,Sabbah A,et al. Is high prevalence of vitamin D deficiency evidence for asthma and allergy risks? [J]. European Annals of Allergy & Clinical Immunology,2011，43(3),81-88.
4. Child Health Professional Committee of Chinese Medical Doctor Association. Follow-up and management recommendations after discharge of premature infants[J].Chinese Journal of Maternal and Child Health,2019,30(90):1048-1052.
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