Nutrient needs and feeding of premature infants. Nutrition Committee, Canadian Paediatric Society.

OBJECTIVE: To recommend appropriate intake of nutrients, food sources and feeding practices for premature infants.

OPTIONS: Unfortified milk from the premature infant's own mother, fortified milk from the premature infant's own mother, formula designed for preterm infants and parenteral nutrition.

OUTCOMES: From birth to 7 days, the minimum achievable goal is the provision of sufficient nutrients to prevent deficiencies and catabolism of nutrient substrate in premature infants; from 7 days to discharge from the neonatal intensive care unit, growth and nutrient retention at a rate similar to that which would have been achieved had the infant remained in utero; and for 1 year following discharge, nutrient intake to achieve catch-up growth.

EVIDENCE: Few randomized clinical trials of feeding infants specific nutrients or of feeding choices have been conducted. On the basis of a MEDLINE search of the literature, committee members prepared reviews of the available information on each nutrient and feeding choice. The reviews were critically appraised by the committee. Recommendations were based on the consensus of the committee.

VALUES: Whenever possible, the evidence was weighed in favour of randomized controlled trials. If such trials were unavailable, cohort studies were considered. If trials of either kind were unavailable, published data were reviewed and recommendations were based on consensus opinion.

BENEFITS, HARMS AND COSTS: The advantages of feeding premature infants unfortified milk from their own mothers are psychologic benefits for the mother as well as anti-infective benefits and possibly improved intellectual development for the infant. However, unfortified milk from the infant's own mother is inadequate as a sole source of nutrients. The use of fortified milk from the mother results in faster growth as well as having the other benefits of mother's milk. When formulas designed for premature infants are given in adequate volumes, they provide an intake of nutrients that allows the infant to duplicate intrauterine growth without undue metabolic stress.

RECOMMENDATIONS: The preferred food for premature infants is fortified milk from the infant's own mother or alternatively, formula designed for premature infants. This recommendation applies to infants with birth weights of a minimum of 500 g to a maximum of 1800 to 2000 g, or with a gestational age at birth of a minimum of 24 weeks to a maximum of 34 to 38 weeks (until the infant is able to nurse effectively).

VALIDATION: These guidelines are in line with, but not identical to, recent guidelines by the Committee on Nutrition of the American Academy of Pediatrics and the Committee on Nutrition of the Preterm Infant of the European Society of Paediatric Gastroenterology and Nutrition.

SPONSOR: The preparation of these guidelines was sponsored and funded by the Canadian Paediatric Society.