From the Guidelines
Complementary feeding for extremely low birth weight (ELBW) infants should begin when they reach 34-36 weeks corrected gestational age or when they demonstrate developmental readiness, typically at 1.5-2 kg weight. The most recent and highest quality study on this topic is not directly provided, but based on the available evidence, it is recommended to start with small volumes (5-10 mL) of breast milk or formula by mouth while continuing gavage feeds, gradually increasing oral feeds as tolerated 1.
Key Considerations
- Assess readiness by looking for signs such as rooting, sucking on pacifiers, and coordinated suck-swallow-breathe patterns.
- Feed the infant in a semi-upright position to minimize aspiration risk, and limit feeding duration to 20-30 minutes to prevent fatigue.
- Begin with 1-2 oral feeds per day and gradually increase frequency as the infant demonstrates improved feeding skills.
- Monitor for signs of feeding intolerance including increased work of breathing, color changes, bradycardia, or desaturation.
- Fortification of breast milk with human milk fortifiers should continue during this transition to ensure adequate caloric and nutrient intake, as breast milk alone may not meet the increased needs of ELBW infants 2.
Nutritional Requirements
- ELBW infants require higher nutrient intake due to their increased energy needs, which can be met through the use of breast milk combined with breast milk fortifier or preterm formulas 2.
- Protein intake should be at a level similar to that of a healthy, growing infant of a similar age, ranging from 3 g/kg/day in early infancy to 1.2 g/kg/day in early childhood 2.
- Vitamin A supplementation may be beneficial in reducing the incidence of bronchopulmonary dysplasia, but the optimal dosing regimen is still unclear 2.
Conclusion is not allowed, so the answer just ends here.
From the Research
Guidelines for Complementary Feeding in ELBW Infants
- The optimal timing and composition of complementary foods for Extremely Low Birth Weight (ELBW) infants is crucial for their growth and development 3.
- Human milk is preferred for ELBW infants, and its composition can vary greatly between mothers, during the day, and over the course of lactation 3.
- Infrared macronutrient analyses can be used to optimize protein and energy intakes in ELBW infants fed human milk 3.
- Fortification of human milk may be necessary to increase protein or energy intakes in ELBW infants 3.
- Parenteral nutrition can be continued until enteral intake constitutes 75-80% of the total volume intake 3.
Micronutrient Intake during Complementary Feeding
- Micronutrient intake is crucial during complementary feeding in very low birth weight (VLBW) infants, and the timing of solid food introduction may affect micronutrient intake 4.
- Iron and phosphorus intake may be higher in VLBW infants introduced to solids early (<17 weeks corrected age) compared to those introduced late (≥17 weeks corrected age) 4.
- Total vitamin D, calcium, zinc, and phosphorus intake may meet recommendations, but dietary iron intake may be insufficient to equalize the iron quantity from supplements during the second half year of corrected age 4.
General Principles of Complementary Feeding
- Complementary feeding is a critical period for physical and cognitive development, and the timing, dose, and duration of exposure to specific nutrients can have both positive and negative effects 5, 6, 7.
- The introduction of complementary foods should be individualized, taking into account the infant's nutritional needs and developmental stage 6, 7.
- Breastfeeding and complementary feeding can have direct or later consequences on health, including growth velocity, infections, and long-term effects such as obesity, cardiovascular disease, and atopic disorders 6, 7.