A baby born before 37 weeks gestation is considered premature. While the preemie has many obstacles to overcome, nutrition and thus, weight gain, is especially vital to his health and development.
Weight Gain and Premature Infants
Weight gain is an important indicator of growth and development for a premature infant.
Desired Rate of Growth
There is a considerable amount of research underway to examine the optimal growth of a premature baby. In Strategies for Feeding the Preterm Infant, printed in the October 2008 issue of Neonatology, the rate of growth of a preterm infant should be consistent with what you would be expected in utero. A minimum growth of 15 g/kg/day is typical growth in utero and is required to get the infant back to expected birth weight post-delivery, regardless of how early the delivery was.
Early Nutrition in the Hospital
Preemies have underdeveloped digestive systems, and often may not have developed the ability suck and swallow. Consequently, preemies born prior to 32 weeks gestation typically need peripheral lines such as an IV, nasogastric tube, or central line to provide nutritional needs right after birth. Premature babies born after 32 weeks may be able to breast feed, but will likely need supplementation, either through a peripheral line, or through formula in a bottle (as tolerated) until they develop further.
According to American Family Physician, in the NICU infants should receive 120cal/kg/day. From Effects of Aggressive Parenteral Nutrition on Growth and Clinical Outcome in Preterm Infants, published in the December 2012 issue of Pediatrics International, it is learned that higher amounts of amino acids and lipids for premature infants correlates to improved growth of the infant by 40 weeks of gestation. Most formulas created for premature infants will provide higher amounts of amino acids, lipids, additional calories and nutrients to support growth.
Bottle and Breastfeeding in the Hospital
Most infants will not develop the suck, swallow reflex until at least 32 weeks gestational age. Until this reflex is in place, breast or bottle feeding is not possible. Once the infant has developed to the point that they can begin taking in nutrition without the support of a peripheral line, bottle or breastfeeding can be added to the regimen.
According to a March 2011 report titled Nutrition of the Preterm Infant, published in the reputable, French publication Archives De Pédiatrie: Organe Officiel De La Sociéte Française De Pédiatrie, breast milk or bottle feeding should be introduced as soon as the infant has developed to the point they can tolerate sucking and swallowing. Prior to 40 weeks gestation, most preemies will be unable to take in much milk with each feeding. Until the baby reaches their desired birth rate, the addition of a formulary supplement will likely be needed to ensure adequate calories and nutrition.
Weight Gain Rates of Formula vs. Bottle Feeding
There is much debate surrounding the benefits of formula over breastfeeding, and vice versa for preterm infants. Because of preterm needs for increased nutrition, formula supplementation will likely be warranted until at least the time the preterm infant reaches his expected birth weight.
In the article, Formula Versus Donor Breast Milk for Feeding Preterm or Low Birth Weight Infant published in the April 2014 edition of the Cochrane Database of Systematic Reviews, researchers analyzed growth patterns of over 1000 premature infants. Their findings indicate preterm infants fed formula exhibited a higher rate of short term growth but also a higher risk of developing necrotizing enterocolitis. You will want to work closely with your pediatrician to monitor your baby's growth and find the best choice for your baby's needs.
Getting Baby Home
There is no magic weight the baby needs to achieve before going home. According to American Family Physician, the following criteria should be met prior to taking baby home:
- Ability to maintain body temperature in an open crib
- Ability to feed by mouth enough to sustain weight gain of 20 to 30 gram per day
- Not on any medications that require hospital personnel to administer
- No recent changes regarding oxygen needs or medications
Your pediatrician will help you decide whether to breastfeed, bottle feed or use a combination of both to ensure your baby is gaining enough weight. Health care provider Meriter suggests the premature baby should be fed every two to four hours at home, as your baby gives you cues that he's hungry. A supplement containing iron and vitamins may be warranted. You will want to monitor your baby's growth at home and follow your pediatrician's recommendations for well-baby office visits.
Work With Your Pediatrician
Survival rates for preemie babies have improved dramatically over the years. Many premature babies grow to be healthy toddlers, teenagers, and eventually adults. You will want to work closely with a licensed pediatrician to make sure your premature infant is receiving optimal care and the right nutrition for their health.