Special Issue "Complementary Feeding in Preterm Newborns"

A special issue of Nutrients (ISSN 2072-6643). This special issue belongs to the section "Nutrition Methodology & Assessment".

Deadline for manuscript submissions: closed (15 August 2021).

Special Issue Editor

Dr. Maria Elisabetta Baldassarre
E-Mail Website
Guest Editor
Department of Biomedical Science and Human Oncology, Section of Neonatology and Neonatal Intensive Care Unit, University of Bari “Aldo Moro”, 70100 Bari, Italy
Interests: preterm newborns; nutrition; microbiota; neonatal gastroenterology; gastroesophageal reflux
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Special Issue Information

Dear Colleagues,

There is increasing evidence that growth rate during fetal life and infancy has important long-term consequences for cardiovascular risk, bone health, and brain development in term and preterm infants. Infant growth may be influenced by diet, including the age at which solid foods are introduced (henceforth referred to as weaning). The introduction of solid foods is associated with major changes in the intake of both macronutrients and micronutrients. Yet, surprisingly, relatively little attention has been paid to the weaning period of preterm infants in terms of the optimal age for weaning, the nature of weaning foods, or whether this period of important dietary change influences later health and development.

This Special Issue aims to clarify some aspects of the introduction of complementary foods in preterm newborns to assist pediatricians in following a common line.

Prof. Maria Elisabetta Baldassarre
Guest Editor

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Keywords

  • preterm newborns
  • nutrition
  • weaning
  • non-conventional weaning
  • post-discharge formula

Published Papers (10 papers)

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Editorial

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Editorial
Complementary Feeding in Preterm Infants: Where Do We Stand?
Nutrients 2020, 12(5), 1259; https://0-doi-org.brum.beds.ac.uk/10.3390/nu12051259 - 29 Apr 2020
Cited by 7 | Viewed by 1134
Abstract
Currently, about 15 million preterm births occur annually worldwide; over 500,000 in Europe and 32,000 in Italy, accounting for 7–11% of total births, with the highest incidence in low-income states [...] Full article
(This article belongs to the Special Issue Complementary Feeding in Preterm Newborns)

Research

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Article
Longitudinal Study Depicting Differences in Complementary Feeding and Anthropometric Parameters in Late Preterm Infants up to 2 Years of Age
Nutrients 2021, 13(3), 982; https://0-doi-org.brum.beds.ac.uk/10.3390/nu13030982 - 18 Mar 2021
Viewed by 793
Abstract
Ensuring the nutritional demands of preterm (PT) infants during complementary feeding could contribute significantly to the infants’ long-term health and development. However, the dietary guidelines for complementary feeding in PT are scarce. Thus, describing dietary intake and identifying nutritional targets for these infants [...] Read more.
Ensuring the nutritional demands of preterm (PT) infants during complementary feeding could contribute significantly to the infants’ long-term health and development. However, the dietary guidelines for complementary feeding in PT are scarce. Thus, describing dietary intake and identifying nutritional targets for these infants could be of great interest. The aim of this study is to assess the food intake and anthropometric parameters in a Mediterranean infant cohort from 6 to 24 months and to identify nutritional targets especially focused on late preterm infants. This is a longitudinal prospective study analyzing information from administered questionnaires about general characteristics and food frequency consumption in 115 infants (20 PT (32 to 36 gestational weeks), 95 full-term (FT)) at 6, 12 and 24 months of age. Results show that the differences in the prevalence of underweight observed in PT infants vs. FT infants are maintained for up to 6 months of age but disappear at 12 and 24 months. The age of inclusion of new foods and the average intake of the main food groups was not different from that of FTs. Although protein intake at 6 months was directly correlated with weight gain and growth in FT, these associations were not observed in PT. At the nutritional level, the low intake of vitamin D in preterm infants is noteworthy. These findings may be useful when designing new intervention strategies for this population group. Full article
(This article belongs to the Special Issue Complementary Feeding in Preterm Newborns)
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Article
Breast Milk for Term and Preterm Infants—Own Mother’s Milk or Donor Milk?
Nutrients 2021, 13(2), 424; https://0-doi-org.brum.beds.ac.uk/10.3390/nu13020424 - 28 Jan 2021
Viewed by 824
Abstract
Hormones are important biological regulators, controlling development and physiological processes throughout life. We investigated pituitary hormones such as follicle-stimulating hormone (FSH), luteinizing hormone (LH), prolactin (PRL) and total protein levels during the first 6 months of lactation. Breast milk samples were collected every [...] Read more.
Hormones are important biological regulators, controlling development and physiological processes throughout life. We investigated pituitary hormones such as follicle-stimulating hormone (FSH), luteinizing hormone (LH), prolactin (PRL) and total protein levels during the first 6 months of lactation. Breast milk samples were collected every fourth week of lactation from mothers who gave birth to preterm (n = 14) or term (n = 16) infants. Donor milk is suggested when own mother’s milk is not available; therefore, we collected breast milk samples before and after Holder pasteurization (HoP) from the Breast Milk Collection Center of Pécs, Hungary. Three infant formulas prepared in the Neonatal Intensive Care Unit of the University of Pécs were tested at three different time points. Our aim was to examine the hormone content of own mother’s milk and donor milk. There were no significant changes over time in the concentrations of any hormone. Preterm milk had higher PRL (28.2 ± 2.5 vs. 19.3 ± 2.3 ng/mL) and LH (36.3 ± 8.8 vs. 15.9 ± 4.1 mIU/L) concentrations than term milk during the first 6 months of lactation. Total protein and FSH concentrations did not differ between preterm and term breast milk. Holder pasteurization decreased the PRL concentration (30.4 ± 1.8 vs. 14.4 ± 0.6 ng/mL) and did not affect gonadotropin levels of donor milk. Infant formulas have higher total protein content than breast milk but do not contain detectable levels of pituitary hormones. Differences were detected in the content of pituitary hormones produced for preterm and term infants. Divergence between feeding options offers opportunities for improvement of nutritional guidelines for both hospital and home feeding practices. Full article
(This article belongs to the Special Issue Complementary Feeding in Preterm Newborns)
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Communication
Complementary Feeding in the Preterm Infants: Summary of Available Macronutrient Intakes and Requirements
Nutrients 2020, 12(12), 3696; https://0-doi-org.brum.beds.ac.uk/10.3390/nu12123696 - 30 Nov 2020
Cited by 1 | Viewed by 914
Abstract
Limited data are available regarding the nutritional needs for preterm infants. In most cases, guidelines refer to the acquisition of neuromotor skills, adequate weight and corrected chronological age. While waiting for the establishment of specific nutritional indications for premature infants we proposed the [...] Read more.
Limited data are available regarding the nutritional needs for preterm infants. In most cases, guidelines refer to the acquisition of neuromotor skills, adequate weight and corrected chronological age. While waiting for the establishment of specific nutritional indications for premature infants we proposed the weaning recommendations for term infants of the Italian Society of Human Nutrition with LARNs (Reference intake Levels of Nutrients and energy for the Italian population) of 2014, the Dietary Reference Values for nutrients of European Food Safety Authority (EFSA) of 2017 and the Nutrient Reference Values for Australia and New Zealand Including Recommended Dietary Intakes of 2017. Full article
(This article belongs to the Special Issue Complementary Feeding in Preterm Newborns)
Article
Premature Birth is an Independent Risk Factor for Early Adiposity Rebound: Longitudinal Analysis of BMI Data from Birth to 7 Years
Nutrients 2020, 12(12), 3654; https://0-doi-org.brum.beds.ac.uk/10.3390/nu12123654 - 27 Nov 2020
Viewed by 1338
Abstract
Adiposity rebound (AR) refers to the second rise of the body mass index (BMI) curve that usually occurs physiologically between five and seven years of age. AR timing has a great impact on patients’ health, since early adiposity rebound (EAR) is associated with [...] Read more.
Adiposity rebound (AR) refers to the second rise of the body mass index (BMI) curve that usually occurs physiologically between five and seven years of age. AR timing has a great impact on patients’ health, since early adiposity rebound (EAR) is associated with the development of metabolic syndrome later in life. We aimed to investigate the prevalence of EAR in a cohort of inborn preterm infants admitted to the Neonatal Intensive Care Section of the Policlinico University Hospital of Bari, Italy. Secondarily, we assessed whether some determinants such as (1) gender; (2) delivery mode; (3) birth weight and classification into small, normal, or large for gestational age; (4) type of feeding; (5) breastfeeding duration; (6) timing of introduction of solid food; (7) parental education; and (8) parental pre-pregnancy body mass index (BMI) influenced EAR in this cohort. The tertiary aim was to evaluate the prevalence of obesity or being overweight at seven years of age in children according to early versus timely AR. This is a prospective, population-based longitudinal study conducted at the Neonatal Intensive Care Section of the Policlinico University Hospital of Bari, Italy. Inborn preterm infants admitted to the neonatal ward between 2009 and 2011 were eligible. Enrolled preterm infants were evaluated at birth and at 1, 3, 6, 9, 12, 15, 18, and 24 months and 3, 4, 5, 6, and 7 years of age. Weight and height data were analyzed, and BMI was calculated. AR was assessed in the growth trajectory in a body mass index (BMI) plot. Of the 250 preterm newborns included, 100 completed the seven-year follow-up and entered the final analysis, 138 were lost during the seven-year follow-up, and in 12 cases parents withdrew over the course of the study. The prevalence of EAR in our cohort of preterm newborns was 54% at seven years of age. Early adiposity rebound was associated with being large for gestational age (LGA) at birth. No other factors were associated with EAR. Early adiposity rebounders had a significantly higher BMI at seven years compared to children with timely AR (17.2 ± 2.7 vs. 15.6 ± 2.05, p = 0.021). No significant differences were found in the prevalence of obesity or being overweight at seven years of age in children with early or timely AR (29% vs. 14%, p = 0.202). Ex-preterm infants have an increased risk of EAR. Since EAR may lead to long-term detrimental health effects with the onset of various chronic diseases (e.g., obesity, metabolic syndrome, etc.), healthcare providers should be prepared to counteract its occurrence, especially in delicate sub-populations of infants. Full article
(This article belongs to the Special Issue Complementary Feeding in Preterm Newborns)
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Article
Concentrated Preterm Formula as a Liquid Human Milk Fortifier at Initiation Stage in Extremely Low Birth Weight Preterm Infants: Short Term and 2-year Follow-up Outcomes
Nutrients 2020, 12(8), 2229; https://0-doi-org.brum.beds.ac.uk/10.3390/nu12082229 - 26 Jul 2020
Cited by 5 | Viewed by 1675
Abstract
Human milk (HM) must be accurately fortified for extremely low birth weight (ELBW) preterm infants with human milk fortifiers (HMFs). Powdered HMF has some limitations in terms of sterilization and accuracy. A concentrated preterm formula (CPF) may serve as a safe liquid HMF [...] Read more.
Human milk (HM) must be accurately fortified for extremely low birth weight (ELBW) preterm infants with human milk fortifiers (HMFs). Powdered HMF has some limitations in terms of sterilization and accuracy. A concentrated preterm formula (CPF) may serve as a safe liquid HMF to facilitate growth. Hence, we launched a quality improvement project for fortification accuracy of minute volume HM. A CPF, Similac Special Care 30 (SSC30), was newly introduced as an HMF when daily feeding reached 100 cm3/kg. CPF + HM (1:2 volume ratio), CPF + HM (1:1 volume ratio), and powdered HMF + HM (1 packet in 25 cm3) represented three fortification stages. Fortification shifted to powdered HMF while tolerable feeding reached 25 cm3/meal. The outcome was compared before (Period-I, January 2015 to June 2016, n = 37) and after the new implement (Period-II, July 2016 to December 2017, n = 36). Compared with the Period-I group, the Period-II group had significantly higher daily enteral milk intake in the first 4 weeks of life, and higher percentages of fortification in the HM-fed infants in the first 8 weeks after birth. The Period-II group also significantly increased in body weight growth in terms of z-score at term equivalent age (p = 0.04) and had better language and motor performance at 24 months old (p = 0.048 and p = 0.032, respectively). Using the liquid CPF as a strategical alternative fortification of HM might be beneficial for extremely preterm infants in terms of growth as well as neurodevelopment. Full article
(This article belongs to the Special Issue Complementary Feeding in Preterm Newborns)
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Review

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Review
Complementary Feeding: Recommendations for the Introduction of Allergenic Foods and Gluten in the Preterm Infant
Nutrients 2021, 13(7), 2477; https://0-doi-org.brum.beds.ac.uk/10.3390/nu13072477 - 20 Jul 2021
Viewed by 734
Abstract
Background: The aim of this systematic review is to analyze the available literature on the introduction of allergenic foods and gluten among preterm infants. Methods: A systematic review of published studies concerning the introduction of gluten and allergenic foods in preterm infants was [...] Read more.
Background: The aim of this systematic review is to analyze the available literature on the introduction of allergenic foods and gluten among preterm infants. Methods: A systematic review of published studies concerning the introduction of gluten and allergenic foods in preterm infants was performed on PubMed and on the Cochrane Library. Results: Of the 174 PubMed results, 15 papers were considered suitable for the review. A total of 83 records were identified through the Cochrane Library search; eight papers were included in the review. Additional papers were identified from the reference lists of included studies. A secondary search was conducted on the same databases to find recommendations and advice regarding healthy full-term infants that could be translated to preterm infants. Therefore, 59 additional papers were included in the review. Conclusions: Current guidelines for the introduction of solid food cannot be directly transposed to preterm infants. Further research is needed to provide evidence-based guidelines regarding weaning in preterm infants. To date, we can suggest that in preterm infants allergenic foods and gluten may be introduced when complementary feeding is started, any time after 4 months of corrected age, avoiding delayed introduction and irrespective of infants’ relative risk of developing allergy. Avoiding large amounts of gluten during the first few weeks after gluten introduction and during infancy is advised, despite limited evidence to support this recommendation. Full article
(This article belongs to the Special Issue Complementary Feeding in Preterm Newborns)
Review
Enteral Nutrition in Term Infants with Congenital Heart Disease: Knowledge Gaps and Future Directions to Improve Clinical Practice
Nutrients 2021, 13(3), 932; https://0-doi-org.brum.beds.ac.uk/10.3390/nu13030932 - 13 Mar 2021
Cited by 1 | Viewed by 1199
Abstract
Optimal nutrition is essential to improve short- and long-term outcomes in newborns with congenital heart disease (CHD). Nevertheless, several issues on nutritional management and concerns about the potential risk of complications related to enteral feeding exist. This narrative review aims to summarize and [...] Read more.
Optimal nutrition is essential to improve short- and long-term outcomes in newborns with congenital heart disease (CHD). Nevertheless, several issues on nutritional management and concerns about the potential risk of complications related to enteral feeding exist. This narrative review aims to summarize and discuss the available literature on enteral feeding in term infants with CHD. A wide variability in feeding management exists worldwide. Emerging approaches to improve nutritional status and outcomes in infants with CHD include: implementation of a standardized enteral feeding protocol, both preoperative and postoperative, clearly defining time of initiation and advancement of enteral feeds, reasons to withhold, and definitions of feeding intolerance; early minimal enteral feeding; enteral feeding in stable term infants on hemodynamic support; evaluation of enteral feeding in term infants with umbilical arterial catheters and during prostaglandin infusion; assessment and support of oro-motor skills; and promotion and support of breastfeeding and provision of mother’s own milk or donor milk when mother’s own milk is not available. As evidence from term infants is scarce, available observations and recommendations partially rely on studies in preterm infants. Thus, well-designed studies assessing standardized clinically relevant outcomes are needed to provide robust evidence and shared recommendations and practices. Full article
(This article belongs to the Special Issue Complementary Feeding in Preterm Newborns)
Review
Preterm’s Nutrition from Hospital to Solid Foods: Are We Still Navigating by Sight?
Nutrients 2020, 12(12), 3646; https://0-doi-org.brum.beds.ac.uk/10.3390/nu12123646 - 27 Nov 2020
Cited by 1 | Viewed by 824
Abstract
As preterm birth rates are globally increasing, together with research on preterms’ peculiar needs, neonatologists are still facing the challenge of how to properly feed them. The need to strike a balance between excessive catch-up growth and extrauterine growth retardation, both leading to [...] Read more.
As preterm birth rates are globally increasing, together with research on preterms’ peculiar needs, neonatologists are still facing the challenge of how to properly feed them. The need to strike a balance between excessive catch-up growth and extrauterine growth retardation, both leading to adverse outcomes, is made even more difficult by the broad range of preterms’ needs. Although mother’s fresh milk is undoubtedly the best nourishment, its availability during hospital stay is often lower than recommended, and its fortification at discharge is still an open issue. Formula milks are available as an alternative to breast milk. However, choosing the right formula requires a thorough evaluation of the infant’s perinatal history and targets. Last but not least, adequate timing and initiation of weaning in premature babies are still a poorly explored matter. This narrative review aims at evaluating the multitude of issues to consider when feeding preterms in the three stages of their first life: in-hospital care, discharge, and, eventually, weaning. Given the current absence of internationally shared guidelines, understanding the potential pitfalls of preterms’ nutrition could help us trace the right path for the right preterm. Full article
(This article belongs to the Special Issue Complementary Feeding in Preterm Newborns)
Review
Complementary Feeding in Preterm Infants: A Systematic Review
Nutrients 2020, 12(6), 1843; https://doi.org/10.3390/nu12061843 - 20 Jun 2020
Cited by 5 | Viewed by 1607
Abstract
Background: This systematic review summarizes available literature regarding complementary feeding (CF) in preterm infants, with or without comorbidities that may interfere with oral functions. Methods: A literature search was conducted in PubMed and the Cochrane Library. Studies relating to preterm infants (gestational age [...] Read more.
Background: This systematic review summarizes available literature regarding complementary feeding (CF) in preterm infants, with or without comorbidities that may interfere with oral functions. Methods: A literature search was conducted in PubMed and the Cochrane Library. Studies relating to preterm infants (gestational age <37 weeks) were included in the analysis. Retrieved papers were categorized according to their main topic: CF timing and quality; clinical outcome; recommendations; strategies in infants with oral dysfunction. Results: The literature search in PubMed retrieved 6295 papers. Forty met inclusion criteria. The Cochrane search identified four additional study protocols, two related to studies included among PubMed search results, and two ongoing trials. Moreover, among 112 papers dealing with oral feeding, four aiming at managing CF in preterm infants with oral dysfunctions were identified. Conclusions: The available literature does not provide specific guidelines on the management of CF in preterm infants, who are generally weaned earlier than term infants. There is a paucity of data regarding the relationship between CF and growth/quality of growth and health outcomes in preterm infants. It could be suggested to start CF between five and eight months of chronological age if infants have reached three months corrected age and if they have acquired the necessary developmental skills. An individualized multidisciplinary intervention is advisable for preterm infants with oral dysfunctions. Full article
(This article belongs to the Special Issue Complementary Feeding in Preterm Newborns)
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