When should premature babies be given complementary foods?

Some women’s pregnancies lead to premature babies due to various reasons. What should we pay attention to in the diet of premature babies? When do babies generally add complementary foods to premature babies? Let’s take a look!

In order to support "Zhang Xin"'s charity event for premature babies, the official account wrote the story of an Australian "watch baby" ("The birth weight is only 705 grams! The tenacious "watch baby", mother Still waiting for you to come home"). I am very reluctant to tell you that the "watch baby" who touched countless people passed away in December 2018. I would suddenly think of him at some random moment when I was driving on the road or watching the children playing in the amusement park. Life is so fragile, and it is lucky for each of us to be born and grow up healthily.

It was probably survivor bias. I remembered that the comments on that article at that time were all examples of hope. Some people said that modern medicine is so advanced that extremely premature babies can survive. Maybe you don’t know, but every premature baby fights with death and doesn’t always win.

I would think that maybe they just tried their best to meet each other and fulfill their fate as relatives.

I write this article for parents of premature babies because I get so many questions about when to introduce solid foods. Every premature baby is an angel who can’t wait to meet their parents. Being born prematurely carries great risks. Nutritional support for premature babies has a great impact on their healthy growth and future health. But we must stay calm and give our babies just the right support: premature babies need extra nutrition, but overfeeding will cause them more harm than ordinary babies.

Being a parent requires wisdom and courage. Being a parent of a premature baby requires even more care, patience, tolerant wisdom and the courage to face difficulties. Come on with your baby!

Timely addition of complementary foods can help babies obtain adequate nutrition and help their growth and development reach optimal levels. For babies born at full term (delivered after 37 weeks of pregnancy), official organizations such as the World Health Organization, my country's Ministry of Health and the American Academy of Pediatrics recommend that babies start adding complementary foods around 6 months old; European Pediatric Gastroenterology, Hepatology and Nutrition The ESPGHAN association's recommendations are slightly different, recommending the introduction of complementary foods no earlier than 17 weeks (4 months) and no later than 26 weeks (6 months).

So when should babies born prematurely (born before 37 weeks of pregnancy) add complementary foods? Regarding this issue, there is still no relatively unified opinion internationally.

1 When should premature babies add complementary foods?

Due to early birth, premature babies miss the third trimester of pregnancy when they actively absorb nutrients, grow rapidly, and gradually mature the functions of various organs in the mother's womb. Therefore, these babies have less nutritional reserves and less organ development after birth. Not mature enough. Because of this, it is obviously not scientific enough to directly copy the complementary food recommendations for full-term babies to premature babies.

However, there are currently not many studies on the introduction of complementary foods for premature infants, and there are no clear international recommendations on the timing of the introduction of complementary foods for premature infants. The only relevant official guidance was published by the British Ministry of Health in 1994: when the weight of premature infants reaches 5 kilograms, the tongue thrust reflex disappears (for example, when feeding with a spoon, the mouth opens and the tongue no longer pushes out food), and the baby can be latched When spooning, it is recommended to start adding solid foods.

Some researchers point out that if the standards of the British Ministry of Health are followed, premature babies born at 23 weeks of gestation may have to wait until 10 months after birth to reach 5 kilograms. Taking into account the needs of growth and development, they believe that most premature babies can eat solid food 5-8 months after birth, provided that the corrected age of these babies reaches at least 3 months, that is, their maximum exercise After reaching a certain level of development, it is safe to eat.

According to recommendations from Alberta Health Services in Canada, all premature babies should be evaluated for signs of “readiness” before introducing complementary foods.

Although there is no strict quantitative requirement for how many "signals" the baby must show, most of the following must appear:

1. Can sit firmly with support, such as leaning on a chair

2. Be able to control the head and neck more stably;

3. Open your mouth when feeding with a spoon and no longer use it The tongue pushes out the food;

4. Can turn the head away after eating to indicate that he does not want to eat;

5. Has a strong interest in adult food, such as staring at adults while eating Look at your food;

6. Have certain eye-hand-mouth coordination, be able to see food, reach out to grab it, hold some finger foods with your hands, and put them into your mouth accurately.

There is no conclusion yet on the specific age at which premature babies should be given complementary foods. Based on the existing evidence and expert opinions, the Alberta Health Services Department believes that when the corrected age reaches 4 to 6 months and most of the above signals have been established, you can consider adding complementary foods to your baby.

"Corrected monthly age" is a commonly used indicator to evaluate the growth and development of premature babies. It is calculated based on 40 weeks of pregnancy (that is, the expected date of delivery). For example, if the baby's due date is June 1st and the birth date is April 1st, then by August 1st, the baby will actually be born 4 months old and the corrected age will be 2 months. According to the recommendations of the American Academy of Pediatrics, the growth and development of premature infants should be evaluated using corrected age in months until they are 2 to 2 and a half years old. Most of the "catch-up growth" of premature babies is completed before this age.

2 Full-term babies should wait until about 6 months before adding complementary foods. If premature babies start taking complementary foods at 4 months of corrected age, will it be too early?

As long as the baby has shown the signs just mentioned, it is not too early. From the perspective of gastrointestinal function, although the digestive ability of premature babies is immature at birth, it will increase with the increase of enteral feeding (especially breastfeeding). Their gastrointestinal function can usually mature before 4 to 6 months of corrected age, allowing them to digest nutrients in complementary foods well. In terms of kidney function, the maturity of kidney function in premature infants can also improve after birth. When the corrected monthly age reaches 2 weeks, the baby's kidneys can already handle the extra load brought by complementary foods, which is much earlier than the time when complementary foods are introduced.

3 If you wait until 6 months after the corrected age before adding complementary foods, will there be any harm to the baby's health?

Children may be unwilling to accept new tastes and foods: As with full-term babies, if solid foods are introduced too late, your baby may have more difficulty accepting new types, flavors, and textures of food.

Nutrient deficiencies may occur, especially iron deficiency: premature babies also need iron-rich foods to ensure good growth and development during their growth. By the way, let’s talk about anemia screening and iron supplementation for premature babies. The American Academy of Pediatrics (AAP) recommends that premature infants be screened for anemia at 4 months after birth and again at 9 to 12 months. Both UpToDate and AAP recommend that all premature infants receive 2 to 4 mg of iron per kilogram of body weight per day after enteral feeding is established. For breastfed premature babies, iron supplements should be started 2 weeks after birth. Formula-fed premature infants should be given iron-fortified formula from the beginning. Whether through iron supplements or iron-fortified formula, iron intake should be at least 2mg/kg per day and continue until 1 year old.

Like full-term babies, the best food for premature babies is still breast milk. Specific benefits of breast milk for premature infants include: helping to prevent infections (such as urinary tract infections and sepsis) and necrotizing enterocolitis, faster initiation of enteral feeding and shorter hospital stays, reduced risk of bronchopulmonary dysplasia, and improved neurodevelopment wait.

However, there are also some problems with breastfeeding for premature infants. In terms of breast milk quantity, mothers may not be able to provide enough breast milk to their premature babies. One study found that only 30% of mothers with extremely premature babies were able to provide enough breast milk to meet their babies' needs. The reasons may involve maternal stress, lack of baby suckling, physiological immaturity of the premature mother's breasts, late start of milk, etc. In terms of nutrition, breast milk cannot provide enough protein, calcium, phosphorus, iron, vitamins, etc. for premature babies.

So, although breast milk is the first choice for premature babies, some babies may also need additional nutritional sources, such as breast milk fortifiers or premature infant formula.

According to UpToDate’s recommendations, premature infants weighing <1500g and infants weighing 1500~1800g and requiring tube feeding need to drink fortified breast milk to increase the intake of calories and nutrients. The specific method is generally to start tube feeding with unfortified breast milk, and add breast milk fortifier when the feeding amount reaches 80ml per kilogram of body weight per day. Next, breast milk is fortified until the baby is able to be fed orally, is growing well, and there is no evidence of any nutritional problems, such as normal alkaline phosphatase, phosphorus, or blood urea nitrogen levels.

In Australia, the practice is similar to UpToDate's recommendations. Hospitals will routinely fortify breast milk for premature infants with a gestational age of ≤31 weeks or a weight of <1500g until the baby reaches a weight of 1800g.

It is only recommended to use premature infant formula if the mother does not have breast milk or has insufficient breast milk, and there is no reliable source of breast milk donation.

Before a premature baby is discharged from the hospital, if necessary, medical staff will select a suitable special formula for premature babies based on the baby's specific condition.

4 Should premature infants continue to use special formula milk after they are discharged from the hospital?

It depends. You can refer to the following principles to determine whether a premature baby needs to continue using special formula milk after being discharged from the hospital. However, in actual practice, doctors still need to make an assessment based on the baby's individual situation.

1. For premature babies with birth weight >1500g and good growth, if breast milk is sufficient after discharge, there is no need to add special formula milk. If breast milk is insufficient, regular formula fortified with iron and long-chain polyunsaturated fatty acids (DHA and ARA) is recommended.

2. Babies whose birth weight is 1500~1800g and whose growth is not ideal may need to continue to fortify breast milk and add special formula milk after discharge.

3. If the growth of premature babies with a birth weight of more than 1800g is not ideal, you can consider fortifying breast milk and adding ordinary formula milk fortified with iron and long-chain polyunsaturated fatty acids (DHA and ARA) until Growth reaches normal standards.

4. If the baby still does not grow satisfactorily after 3 months of birth, it may be necessary to continue to fortify breast milk and add special formula milk depending on the situation until the corrected age is 6 to 12 months.

Summary

At present, the research on the introduction of complementary foods for premature babies is still limited, and there is a lack of clear recommendations on the introduction time. Based on the existing evidence and expert opinions, when the corrected age reaches 4 to 6 months and the baby shows signs of adding complementary foods, you can start adding complementary foods.

Due to the possibility of insufficient breast milk and the inability of breast milk nutrition to meet the needs of premature infants, some babies need to use breast milk fortifiers and/or special formulas for premature infants, especially those with birth weight <1500g. .