Nestlé Nutrition Institute Workshop Series

Providing a human milk fortifier once the preterm infant has started to suckle at the breast can be challenging for the mother and might shorten duration of the breastfeeding period. Fortification is recommended up to term for the normal-growing infant and up to 3 months in growth-retarded infants. After hospital discharge, some mothers may not want to pump, fortify, and bottle-feed the fortifier-milk mixture any longer. They desire to breastfeed their infants directly from the breast, but unfortunately, fortification often interferes with direct breastfeeding...

Mother's own milk is universally recognized as the optimal source of nutrition for preterm infants, although most authorities agree a multi-nutrient fortifier must be added in order to support nutrient accretion at a rate comparable to in utero. Nevertheless, many preterm infants face a gap between achieved growth and what could have been achieved in utero. In this narrative review, we provide an overview on the macronutrient content in mother's own milk and donor milk and how this can be enhanced by the various available multi-nutrient fortifiers...

Birth represents the start of an incredible journey for the individual and the microbes which reside within and upon them. This interaction between human and microbe is essential for healthy development. Term infants are colonized by bacteria at birth, and thereafter the diet is the most important factor shaping the gut microbiome, in particular receipt of human milk. Human milk contains viable bacteria and numerous components that modulate the bacterial community, including human milk oligosaccharides (HMOs) which promote the growth of Bifidobacteriumspecies...

For preterm and small-for-gestational age infants on enteral nutrition, the best solution is to add human milk fortifier (HMF) to human milk (HM) which is provided by the mother or a milk bank. HMF provides a means to add additional protein, energy, and micronutrients, while maintaining HM as the main source of nutrition. Because of their rapid increase of lean body mass, preterm infants have much higher protein requirements than term infants. Recommendations on protein requirements of preterm infants are available, but protein quality - i...

Deficiency or excess of specific micronutrients is common in preterm infants and can have many effects on health outcomes, ranging from life-threatening electrolyte disturbances to long-term effects on growth, brain development, bone health, and the risk of retinopathy of prematurity (ROP). Iron supplementation of low birth weight infants reduces the risk of behavioral problems. However, due to the risk of adverse effects, iron supplementation of very preterm infants in the NICU should be individualized, considering birth weight, postnatal age, diet, and serum ferritin concentrations...

Infants born very preterm miss out on the in utero transfer of the omega-3 and omega-6 long-chain polyunsaturated fatty acids that occurs during the third trimester. A number of studies have explored the impact of increasing the enteral intakes of omega-3 +/- omega-6 long-chain polyunsaturated fatty acids to match fetal accretion rates in such infants. These studies have shown early transient improvements in vision and development with both strategies, but with the use of omega-3 supplementation alone appearing to increase the incidence of bronchopulmonary dysplasia...

Recommendations for nutrition of very preterm and very low birth weight infants have developed over time with our understanding of the requirements of preterm babies and the awareness of widespread poor postnatal growth. In general, the trend has been towards enhancing nutrition, but more recent recommendations have begun to raise questions with respect to the potential for high and early nutritional intakes, particularly of protein, to carry risks such as refeeding syndrome. However, large gaps in our knowledge remain for both macro- and micronutrient requirements to support optimal growth and how nutrition and growth relate to important long-term outcomes...

Gut microbiota plays an important role in infants' health. The prevalence of bifidobacteria in the gastrointestinal tract of term breastfed infants has been associated with reduced infection rates compared with formula-fed infants. However, few studies evaluated microbiota in premature infants. In an observational study of 577 preterm newborns born below 32 weeks gestation, gut microbiota was not driven by bifidobacteria but could be classified into six different clusters with regard to the most abundant bacteria present...

The last 20 years have seen dramatic improvements in survival for preterm infants in both high- and low-income settings. Survival rates of over 50% in infants born 16 weeks early (24 weeks' gestation) are now commonplace in well-resourced neonatal intensive care units. However, ensuring adequate nutrient intakes especially in the first few days and weeks is challenging, and many infants show poor growth and nutritional status. Good nutritional management should be seen as the cornerstone of good neonatal care and is key to improving a range of important outcomes including reduced rates of retinopathy of prematurity, chronic lung disease, necrotizing enterocolitis (NEC), and sepsis...

The benefits of breastfeeding, such as reduced risk of gastrointestinal and respiratory tract infections, depend largely on the presence of bioactive compounds in breast milk, including human milk oligosaccharides (HMOs). The presence of HMOs represents one of the largest differences in composition between breast milk and infant formula. Currently, progress in biotechnology allows the production of selected HMOs such as 2'-fucosyllactose (2'-FL) and lacto-N-neotetraose (LNnT), which are increasingly being added to infant formulas to narrow the difference between breast milk and formula...

Approaches to enteral feeding significantly preterm infants' impact short-term outcomes including survival, late-onset sepsis (LOS), and necrotizing enterocolitis (NEC), and neurodevelopmental and later health outcomes. Clinical practice and trial data are dominated by short-term outcomes (NEC and LOS) with limited longer-term outcomes. Strategies maximizing early maternal breast milk (MOM) exposure and duration of MOM use are key given global health benefits of MOM, but few feeding trials use these as outcomes...

Stress exposure during sensitive developmental periods lastingly affects brain function and cognition and increases vulnerability to psychopathology later in life, as established in various preclinical and clinical studies. Interestingly, similar patterns are seen in children who suffer from perinatal malnutrition. Stress and malnutrition can act closely aligned and stress and nutrition interact. There is emerging evidence that specific nutritional supplementation during various time windows may ameliorate the long-lasting effects of early-life stress, although possible mechanistic insights in this process are sparsely reported...

No abstract text is available yet for this article.

No abstract text is available yet for this article.

To understand the development of children's flavor preferences, it is important to consider the context of the feeding environment. Although children are predisposed to prefer sweet-tasting foods and beverages and to avoid bitter-tasting foods such as dark-green vegetables, parents can play a central role in shifting these innate food acceptance patterns throughout development. Beginning before birth, the fetus detects the continually changing flavor profile of amniotic fluid, which reflects the mother's diet...

Over the course of evolution, Mother Nature preserved the ability of humans to make every sugar they need for metabolic functions. Glucose is the almost exclusive fuel preferred by the human brain. Human infants are born with sweet taste receptors, sugars are a significant energy source in human milk, and mammals have a direct gut-to-brain sugar-sensing system that enhances development of a preference for sugars. If sugars are as toxic as many postulate, what species advantage was conferred by this evolutionary progression? Observational studies have reported that sugar consumption is associated with various adverse health risks...

Motor skills are important for development. Everything infants do involves motor skills - postural, locomotor, and manual actions; exploratory actions; social interactions; and actions with artifacts. Put another way, all behavior is motor behavior, and thus motor skill acquisition is synonymous with behavioral development. Age norms for basic motor skills provide useful diagnostics for "typical" development, but cultural differences in child-rearing practices influence skill onset ages. Whenever they emerge, motor skills lay the foundation for development by opening up new opportunities for learning...

Today, children are less active than previous generations leading to an increased prevalence of morbidity associated with physical inactivity. Globally, full-day preschool is rapidly becoming the norm. Thus, the amount of time that a child spends outside the home is an opportunity for schools and teachers to educate children about the importance of participating in physical activity and making healthy eating choices. One approach to comprehensively offer opportunities for physical activity and healthy eating is called Whole School, Whole Community, Whole Child, which intertwines academic success and promotion of healthy behaviors...

The great majority of attention on growth faltering concentrates on the first "1,000 days" with a much lesser focus on toddlers and young preschoolers. The rationale for this is understandable since the first 1,000 days cover the period of most rapid growth and changes in body composition, the period of breastfeeding, and the complex transition from breastfeeding and weaning to complementary feeds, and then moving to the family/adult diet. There has also been a strong perception that, once a child has become stunted or wasted in the first 2 years of life, there is little hope of recovery, an assumption we address below...

No abstract text is available yet for this article.