World Prematurity Day: What is the ideal nutrition for a very low birth weight baby?

Prematurity and the occurrence of low birth weight are both leading causes of neonatal mortality in the world. Babies born with low birth weight have an increased risk of early growth deficit, infections, developmental delays, and death during infancy and childhood.

How low is a low birth weight for premature babies?

Depending on the birth weight, a baby will be categorized into one of the following categories: 

•       Between 2.5 kg and 3.5 kg is the normal birth weight
•       A baby less than 2.5 kg is considered to be at low birth weight
•       Less than 1.5 kg is considered very low birth weight (VLBW)
•       Less than 1 kg is considered extremely low birth weight (ELBW)

The risk of complications such as sepsis or necrotising enterocolitis (NEC) is inversely related to the birth weight. Babies in the lowest weight category are at the highest risk.

What about NEC? How does it harm the baby?

NEC is a potentially life-threatening disorder of the gastrointestinal tract, which occurs when intestinal tissue dies. It is characterized by abdominal distention, low platelet count, low sodium levels in blood, temperature instability, and shock. The condition affects most preemies and sick babies, who have low birth weight or are premature. 

The treatment may require invasive surgery, which can have lifelong effects. Several studies have indicated that although NEC is multi-factorial, intake of bovine milk-based products is a major risk factor.

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The majority of VLBW and ELBW infants are either preterm birth or they are small for gestational age, or both. Interventions aimed at improving the nutritional status of VLBW and ELBW infants can improve the immediate and long-term health of the infant, provided the optimal choice of human milk diet is adhered to.

What is the solution for premature babies?

According to Dr Geetika Gangwani, lactation consultant, “Ensuring access to a human milk diet is vital to a newborn’s survival as well as their brain development and other organ functions. Human milk, when fed within the first hour of delivery, works as an elixir for the baby, protecting them against infections and other health complications. The World Health Organization recommends the usage of screened, pasteurized donor human milk in the absence of the mother’s own milk.”

In addition to providing antibodies, human milk is also easy to digest. As per Dr Vikram Reddy, Chief Scientific Officer at NeoLacta Lifesciences, all essential nutrients necessary for a baby’s growth and development are present in human milk along with immunological factors to fight infectious diseases. Human milk is also gentle on the baby’s developing stomach and intestines, making it the optimal nutrition for infants.

Dr Amitava Sengupta, Director, Mother and Child Unit, Neonatology and Paediatrics, Paras Hospitals, Gurgaon (NCR), says, “Preterm birth is a global burden, which is seen in both developing as well as developed countries. We prescribe an exclusive human milk diet for all infants, especially those born prematurely with a birth weight of fewer than 1,500 grams., considering their extra nutritional requirements and immature organ systems.”

What is an exclusive human milk diet?

It includes a combination of mother’s milk, screened pasteurized milk from a qualified donor, and fortifiers derived from human milk. Preemies fed on an exclusively human milk diet may be protected against NEC, sepsis as well as various infections and chronic diseases. It is prudent to counsel mothers going in for impending preterm deliveries and explain to them the prime importance of increased frequency (6 to 8 times/24 hours) of expression of breast milk. Following this process devotedly will assure an adequate flow and volume of breast milk for the newborn within the first week of life.

Needless to mention, exclusive human milk feeding has also been positively associated with improved neurocognitive outcomes.

Milk and products from bovine sources are best avoided for premature babies

Giving bovine milk can make the baby vulnerable to not only infections, but may also cause allergies and adverse reactions. Additionally, bovine milk is difficult for the baby to digest, making it potentially harmful for his/her health.

Additionally, bovine milk-based products do not provide critical components of human milk such as Immunoglobulins and human milk oligosaccharides, among others. Clinical evidence shows that mixing human milk with such products may even degrade the nutritional properties of human milk, such as reduction of anti-bacterial properties and higher incidence of feed intolerance.

Lastly, don’t forget, even the slightest negligence in the care of premature babies can be life-threatening, because they are fragile and their organs are still developing. They require utmost care even after going home, along with regular follow-up with their doctor.