[Breastfeeding in premature infants].

Preterm infants have fewer nutrient reserves at birth than term infants. Additional physiological and metabolic stress factors, such as infection or respiratory distress, can affect their nutritional needs and metabolism. Hence, the provision of appropriate nutrition for growth and development is a cornerstone of care of preterm infants. Well infants of a gestational age > 34 weeks are usually able to suck effectively and coordinate swallowing and breathing. Therefore establishment of breast feeding seems reasonable for newborns of this gestational age. For less mature infants, national and international advisory boards also recommend enteral human milk feeding early postnatally. Challenges remain, particularly in establishing evidence-based standards of breastfeeding and the use of human milk for preterm infants in the intensive-care nursery. This article highlights the aspects of growth and nutritional needs, infection prophylaxis and neurological development with regard to the use of human milk versus formula for the preterm infant. Approaches to the initiation and maintenance of milk supply and the decision about when to replace gavage by breast feeding are illustrated.