Departments of Pediatrics and Clinical Pharmacology, Medical University Vienna, Vienna, Austria.
Nestle Nutr Inst Workshop Ser. 2021;96:34-44. doi: 10.1159/000519399. Epub 2022 May 10.
In preterm infants, the key goals of nutrition are to establish adequate growth and to contribute to appropriate neurodevelopmental outcome. In this context, the postdischarge period is crucial to establish catch-up growth and avoid wrong metabolic programming caused by overfeeding. Breastfeeding is strongly recommended, and for preterm infants the European Society for Gastroenterology, Hepatology, and Nutrition (ESPGHAN) suggests fortifying breastmilk after discharge up to term in appropriate growing infants and up to 3 months in growth-retarded infants. If breastfeeding is not possible, postdischarge formula should be fed at least up to term. However, the effects of a higher nutrient density and energy administered by breastmilk fortification or postdischarge formula on growth and neurodevelopmental outcome are limited or missing but might have a positive impact on lung function and vision later in life. Moreover, little is known on the optimal timepoint to introduce solids in preterm infants. Data from observational studies have shown that preterm infants are weaned early in life around 13-15 weeks of corrected age. The degree of prematurity and use of formula are major determinants for early complementary feeding introduction. It is emphasized that there should be a strong focus on the infant's anatomical, physiological, and oral-motor readiness to receive foods other than breast milk or formula. Feeding problems and preterm's eating difficulties are common, and especially in the very immature population approximately 30% show oro-motor dysfunction or avoidant behavior at 3 months. An individualized approach according to the infant's neurological ability and nutritional status seems to be the best practice when introducing complementary feeding in preterm infants especially in the absence of evidence-based guidelines.
在早产儿中，营养的关键目标是实现足够的生长，并有助于适当的神经发育结果。在这种情况下，出院后时期对于建立追赶生长和避免过度喂养引起的错误代谢编程至关重要。母乳喂养强烈推荐，对于早产儿，欧洲胃肠病学、肝病学和营养学会（ESPGHAN）建议在适当生长的婴儿中，在出院后至足月期间对母乳进行强化，在生长迟缓的婴儿中，在出院后至 3 个月期间对母乳进行强化。如果无法进行母乳喂养，则应至少在出院后至足月期间喂食配方奶。然而，通过母乳强化或出院后配方奶提供更高的营养密度和能量对生长和神经发育结果的影响有限或缺失，但可能对以后的肺功能和视力产生积极影响。此外，对于早产儿何时开始添加固体食物，知之甚少。观察性研究的数据表明，早产儿在生命早期，即校正年龄 13-15 周时，就会过早地开始断奶。早产程度和配方奶的使用是早期补充喂养引入的主要决定因素。需要强调的是，应该高度关注婴儿接受母乳或配方奶以外食物的解剖、生理和口腔运动准备情况。喂养问题和早产儿的进食困难很常见，特别是在非常不成熟的人群中，约有 30%的婴儿在 3 个月时表现出口腔运动功能障碍或回避行为。在引入早产儿补充喂养时，根据婴儿的神经能力和营养状况采取个体化方法似乎是最佳实践，特别是在缺乏循证指南的情况下。
