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Ernesto Valdes MD, Guest Editor
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Post Discharge Feeding
Post Discharge Nutritional Support for the Premature Infant. Presented by: Richard Schanler, M.D. Albert Einstein College of Medicine, N.Y.
One of our concerns for the Post-Discharge Period is that the neonatal period is critical for “programming”. Questions that are raised: Does early nutrition affect later health and development? When should we switch from “super milks” to “routine milks”? Should we worry about slow growth in follow up? There is scant information on post discharge nutrition!
We know that 30% of less than 1500 gm infants weigh less than the 5th percentile @ 12 months of age. 21% are less than the 5th percentile in length; 14% are less than the 5th percentile in head circumference.
We have seen that poor growth is associated with early weaning, introduction of solid food and cow’s milk feeding. By 8 years of age they are still lagging.
We know very little on how to base the post-discharge nutrient needs for the premature infant. Do we base it on intrauterine accretion rates? On term infant references?
Researchers have been trying to convince our society to use enriched formulas or enriched breast milk post discharge. But there are still lots of us to be convinced.
We should include nutrition in discharge planning! A suggested approach in deciding post discharge nutrition starts by asking three questions:
1) Can the baby consume volumes greater than 180 ml/kg/day?
2) Is weight gain adequate?
3) Are nutritional indices appropriate? (BUN, Alkaline Phosphatase, and Serum Phosphorus).
If all of the above answers are yes, one may use breastfeeding exclusively or term formula. If there are no answers, perhaps a combination of Human Milk and formula or an enriched formula is better.
Post-discharge nutritional monitoring would consist of nutritional screening assessment @ one week after discharge and at 4-6 weeks after discharge.
Post-discharge nutritional screening assessment would include:
Ø weight gain: (> 20 gm /day);
Ø length (> 0.5 cm / wk).;
Ø head circumference (> 0.5 cm / wk);
Ø Biochemical Tests: (Phosphorus > 4.5 mg/dl; Alk phos < 450 IU/L and BUN > 5 mg/dl).
Comment: We need to have further studies and guidelines for our VLBW infants post-discharge. It is important that the transfer of nutritional information from the neonatologist to the pediatrician is seamless. EV.
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