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FEEDING A PRETERM BABY
The preterm babies are those who are born before 37 weeks of gestation. Goal of feeding the preterm is to achieve a growth rate that approaches the normal growth rate of foetus in uterus.
The preterm is at a disadvantage in many aspects of nutrition. The problem facing the preterm are, poor sucking and swallowing reflexes, relatively high caloric requirement with small stomach capacity, and incompetent cardiooesophageal sphincter leading to aspiration, decreased absorption of essential nutrients.
The caloric need of non-growing preterm babies during the first week of life are 60 kcal / kg / day. After first one or two weeks of life most preterm babies require 120 - 150 kcal / kg / day to maintain satisfactory growth. High calories may be necessary in babies who are not gaining weight, post - operative patients and extreme preterms.
Low cost supplementary foods
Name : Composition
Indian Multi purpose Food (CFTRI) : Low fat groundnut flour and bengal gram flour (75:25) fortified with vitamins A, D, B1, B2, and calcium carbonate. Contains 42 percent protein.
Malt food (CFTRI) : Cereal malt, low fat groundnut flour, roasted bengal gram flour (40:40:20) fortified with vitamins and calcium salts. Contains 28 percent protein.
Balahar (CFTRI) : Whole wheat flour, ground nut flour, and roasted bengal gram flour (70:20:10) fortified with calcium salts and vitamins Contains 20 percent protein
Supplementary food (NIN) : Roasted wheat flour, green gram flour, groundnut and sugar or Jaggery (30:20:8:20) contains 12.5 percent protein.
Kuzhandai Amuthu (ADU) : Roasted maize flour, green gram flour, roasted groundnut and Jaggery (30:20:10:20) contains 14.4 percent protein.
Win food (Gandhigram rural Institute) : Pear millet, green gram dhal, groundnut flour and jaggery (50:15:25:25). Contains 20 percent protein.
Amutham : Rice flour, ragi flour, bengal gram flour, sesame flour, groundnut flour and Jaggery (15:15:15:10:10:25). Contains 14 percent protein.
Poshak : Cereal (Wheat / maize / rice / jowar), pulse (Channa dal or green gram dhal) and oil seed (Ground nut) and jaggery (4:2:1:2)
Amirtham ADU : Wheat (roasted) - 37.5 g, roasted bengal gram - 18.8 g, soyaflour 6.2 g, groundnut 12.5 g, beet sugar 25 g.
Fluid needs of the preterm babies are relatively high during the first week of life. The intake of fluids varies from 90 - 100 ml / kg / day for 7 - 10 days. Additional fluids may be required when the baby is under the phototherapy or a radiant warmer.
Very low birth weight babies may have difficulty in tolerating the lactose the first few days. Glucose polymers are well tolerated.
Preterm babies require 3 - 4 g of protein per kilogram of body weight for rapid growth. Certain amino acids essential for the preterm such as cystine, taurine, alanine and arginine are present in breast milk.
Very low birth weight babies poorly digest and absorb saturated triglycerides. Vegetable oils containing unsaturated long chain fatty acids are better absorbed. Better still are medium chain triglycerides because their digestion and absorption are not dependent on bile salt level.
Calcium and phosphorus supplements may be needed to prevent rickets or osteopenia in preterms. Iron deficiency can occur by 6 - 12 weeks and hence 2.5 mg / kg / day of iron starting from 6 - 8 weeks of age may be given.
All low birth weight babies should receive vitamin supplementation in addition to the amount present in human milk.
The preterm babies are best fed with unprocessed human milk obtained from their mothers. It has been shown that milk of mothers delivering premature babies has higher caloric, fat, protein and sodium content which is suitable for the nutritional needs of low birth weight babies. Antimicrobial property of breast milk is of great importance to the preterm baby. If the baby does not gain weight satisfactorily with breast milk alone, dietary supplements like vegetable oils (corn oil, groundnut oil) may be used which increase the calorie value without increasing its volume.
When human milk feeding is not possible one must resort to animal milk or formula feeds.
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