Nutrition ✅

Question 1

Is human breastmilk the optimal form of nutrition for extremely pre-term babies?

Answer 1

Yes

Question 2

What are the advantages of breastmilk in extremely pre-term babies?

Answer 2

• GI tolerance better
• Reduces risk of necrotising enterocolitis
• Reduces risk of systemic infection
• Help prime bacterial colonisation of gut

Question 3

What is often a problem when breastfeeding extremely pre-term babies?

Answer 3

Lack of success in producing sufficient breast milk

Question 4

What can aggravate the lack of success in producing breast milk with extremely pre-term babies?

Answer 4

• Physical separation of mother and baby
• Difficulty in maintaining milk supply over long period
• Lack of motivation
• Inadequate support

Question 5

What can improve the volume and duration of breastfeeding in extremely pre-term babies?

Answer 5

• Frequent expression
• Kangaroo care or skin to skin contact
• Relaxation tapes

Question 6

What can improve production of breast milk?

Answer 6

• Breast pumping
• Massage prior to pumping
• Dopamine antagonists

Question 7

What is increasingly being used when mother’s milk is not available?

Answer 7

Expressed donor milk

Question 8

What happens to expressed donor milk before being given to the baby?

Answer 8

It is pooled and pasteurised

Question 9

What can be given if breastmilk or expressed donor milk are not available?

Answer 9

Preterm infant formula

Question 10

How does preterm infant formula differ from standard formula?

Answer 10

It has been modified to meet the increased nutrient requirements of extremely preterm infants

Question 11

What does the use of a special formula for preterm infants result in?

Answer 11

• Faster weight, length, and head circumference growth
• Reduced incidence of hyponatraemia
• Reduced incidence of bone disease of prematurity
• Reduced incidence of hypophosphataemia
• Reduced incidence of hyperbilirubinaemia

Question 12

What is the disadvantage of using infant formula in extremely preterm babies?

Answer 12

• Poorer tolerance of feeds

- Risk of NEC is increased

Question 13

What is widely used to supplement expressed breast milk in extremely pre-term infants?

Answer 13

Human milk fortifiers containing protein, energy, macrominerals, trace minerals, and a range of vitamins

Question 14

What is the advantage of human milk fortifiers?

Answer 14

They provide short-term improvements in weight gain, linear and head growth

Question 15

What are the limitations of human milk fortifiers?

Answer 15

Evidence is lacking for long-term benefits

Question 16

What are human milk fortifiers based on?

Answer 16

Cow’s milk

Question 17

What is the result of human milk fortifiers being based on cow’s milk?

Answer 17

Their precise biological properties differ from that of human milk

Question 18

What has more recently been used as a human milk fortifier?

Answer 18

‘Humanised’ milk fortifier

Question 19

What is humanised milk fortifier based on?

Answer 19

Pooled donor breast milk

Question 20

What is the advantage of humanised milk fortifier?

Answer 20

Lower risk of NEC compared to preparations based on cow’s milk

Question 21

When is parenteral nutrition required in pre-term babies?

Answer 21

If adequate enteral feeding is not possible

Question 22

Why is parenteral nutrition often required in pre-term babies?

Answer 22

Extremely preterm infants have very limited ability to withstand starvation due to their low protein, fat, and carbohydrate stores