Breast milk expressed by the infant's mother is the preferred type of feeding for most preterm infants. It is nutritionally superior to artificial formula in many respects. There is improved gastric emptying, more stool frequency, and improved fat absorption when breast milk is used. There are many trophic factors found in human milk that enhance the development of the gastrointestinal tract. Human milk contributes to host defense and reduces the risk of NEC. Preterm infants who have been fed expressed human milk also show a neurodevelopmental advantage but it is difficult to isolate this from the social variables also associated with mothers willing to express their milk. The use of expressed breast milk also enhances mother-infant bonding as this is one task that only the baby's mother is able to perform. However, there are also nutritional concerns related to the use of breast milk in infants born less than 33 weeks' gestation. Protein supplementation is necessary for optimal growth and maintenance of optimal protein status. Supplementation of calcium and phosphorous is also needed for adequate bone mineralization. There are multinutrient fortifiers available that can be added to breast milk to improve nutrient intake. The use of these fortifiers has been associated with improved intake of protein and minerals and growth and bone mineralization, and balance studies show improved nutrient retention.
If breast milk is not available, the feeding of choice becomes preterm infant formulas. These formulas have greater protein content and are cow's milk whey predominant. The carbohydrate is a mixture of lactose and glucose polymers, and the fat a mixture of both long-chain and medium-chain triglycerides for improved nutrient absorption. The concentration of minerals, electrolytes, and vitamins is increased to meet the estimated nutrient needs of the preterm infant when fed in an amount to provide 120kcalkg-1 day-1. Studies have shown that infants fed preterm infant formulas have improved growth over those fed term formula or even fortified breast milk.
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