Chapter 14: Formula Feeding

SCOPE

Use of preterm infant formula for very low birth weight (VLBW) infants.

DISEASE/CONDITION(S)

Nutritional support for VLBW infants with preterm formula.

GUIDELINE OBJECTIVE(S)

Indications for the use of preterm formula in VLBW infants.

BRIEF BACKGROUND

The guiding principles for all nutritional strategies and products that we use in these VLBW infants is that undernutrition is by definition nonphysiologic and undesirable. Any measure that diminishes inadequate nutrition is inherently good as long as safety is not compromised. Improving nutritional status and therefore growth will optimize neurodevelopmental outcomes.

Enteral nutrition is provided to these VLBW infants with either human milk or preterm formula. The America Academy of Pediatrics (AAP) recommends human milk as the preferred feeding for all of these infants, including the use of donor milk where their own mother’s milk is preferred but not available. It is also clear that human milk fortifiers are required to meet the nutritional needs of the VLBW infants receiving own mother’s milk or donor milk.

Formula is an option if there is an inadequate supply of mother’s milk, donor milk is unavailable, or the mother is unable for other reasons to provide milk. Premature formula meets the nutrient needs of the growing VLBW infant but is absent of many important bioactive factors in human milk.

IMPORTANCE OF NUTRITION FOR VLBW INFANTS

These VLBW infants have greater nutritional needs to achieve optimal growth during their neonatal period than any other time in their lives. The reasons for this include:

1. Birth at the beginning of the third trimester of pregnancy is often associated with growth restriction because they have not received the nutrients that are plentiful during the third trimester.

2. Critical illnesses and associated complications such as respiratory distress, acidosis, hypoxia, sepsis, and gastrointestinal complications all increase metabolic requirements.

3. Difficulty in tolerating both parenteral and enteral feedings make provision of nutrients more challenging, and drugs such as steroids may impede growth as well.

Directly linking nutrient intake and outcome was demonstrated in a study where preterm infants fed an enriched preterm formula with higher protein and energy for the first month of life had higher scores in neurodevelopmental indices at 18 months and sustained at 8 years of life than those infants receiving a standard term formula. Scores at 8 years of life are predictive of adult outcomes.

NEED FOR ADDITIONAL ENERGY AS WELL AS HIGHER PROTEIN IN HIGH-PROTEIN FORMULAS

The higher concentrations of protein in these formulas also have increased energy content. Both energy and protein are necessary for growth of body weight, length, and head circumference. Energy is required for synthesis of and depositing protein and fat. These VLBW infants probably need a ...