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Feeding the Late and Moderately Preterm Infant

A Position Paper of the European Society for Paediatric Gastroenterology, Hepatology and Nutrition Committee on Nutrition

Lapillonne, Alexandre*,†; Bronsky, Jiri; Campoy, Cristina§; Embleton, Nicholas||; Fewtrell, Mary; Mis, Nataša Fidler#; Gerasimidis, Konstantinos**; Hojsak, Iva††; Hulst, Jessie‡‡; Indrio, Flavia§§; Molgaard, Christian||||; Moltu, Sissel Jennifer¶¶; Verduci, Elvira##; Domellöf, Magnus*** ESPGHAN Committee on Nutrition:

Journal of Pediatric Gastroenterology and Nutrition: May 13, 2019 - Volume Publish Ahead of Print - Issue - p
doi: 10.1097/MPG.0000000000002397
Societal Paper: PDF Only

ABSTRACT Nutritional guidelines and requirements for late or moderately preterm (LMPT) infants are notably absent, although they represent the largest population of preterm infants. The European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) Committee on Nutrition (CoN) performed a review of the literature with the aim to provide guidance on how to feed infants born LMPT, and identify gaps in the literature and research priorities.

Only limited data from controlled trials are available. Late preterm infants have unique, often unrecognized, vulnerabilities that predispose them to high rates of nutritionally related morbidity and hospital readmissions. They frequently have feeding difficulties that delay hospital discharge, and poorer rates of breastfeeding initiation and duration compared with term infants. This review also identified that moderately preterm infants frequently exhibit postnatal growth restriction.

The ESPGHAN CoN strongly endorses breast milk as the preferred method of feeding LMPT infants and also emphasizes that mothers of LMPT infants should receive qualified, extended lactation support, and frequent follow-up. Individualized feeding plans should be promoted. Hospital discharge should be delayed until LMPT infants have a safe discharge plan that takes into account local situation and resources.

In the LMPT population, the need for active nutritional support increases with lower gestational ages. There may be a role for enhanced nutritional support including the use of human milk fortifier, enriched formula, parenteral nutrition, and/or additional supplements, depending on factors, such as gestational age, birth weight, and significant comorbidities. Further research is needed to assess the benefits (improved nutrient intakes) versus risks (interruption of breast-feeding) of providing nutrient-enrichment to the LMPT infant.

*Paris Descartes University, APHP Necker-Enfants Malades hospital, Paris, France

CNRC, Baylor College of Medicine, Houston, TX

Department of Paediatrics, University Hospital Motol, Prague, Czech Republic

§Department of Paediatrics, University of Granada, Spain

||Newcastle Neonatal Service, Newcastle Hospitals NHS Trust and Newcastle University, Newcastle upon Tyne, UK

Childhood Nutrition Research Centre, UCL GOS Institute of Child Health, London, UK

# Department of Gastroenterology, Hepatology and Nutrition, University Children's Hospital, University Medical Centre Ljubljana, Slovenia

**Human Nutrition, School of Medicine, Dentistry and Nursing, University of Glasgow, New Lister Building, Glasgow Royal Infirmary, Glasgow, UK

††Children's Hospital Zagreb, Croatia, University of Zagreb School of Medicine

‡‡Division of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, Toronto, Canada

§§Ospedale Pediatrico Giovanni XXIII University of Bari, Italy

||||Department of Nutrition, Exercise and Sports, University of Copenhagen, and Pediatric Nutrition Unit, Copenhagen University Hospital, Rigshospitalet, Denmark

¶¶Department of Neonatal Intensive Care, Oslo University Hospital, Norway

##Department of Pediatrics, San Paolo Hospital, Department of Health Sciences, University of Milan, Mian, Italy

***Department of Clinical Sciences, Pediatrics, Umeå University, Umeå, Sweden.

Address correspondence and reprint requests to Alexandre Lapillonne, MD, PhD, Neonatal Department, Necker-Enfants Malades hospital, 149 rue de Sevres, 75015 Paris, France (e-mail:

Received 9 January, 2019

Accepted 2 May, 2019

M.D. is the Chair and J.B. is the Secretary of Committee on Nutrition.

A.L. received lecture fees and/or nonfinancial support from Baxter, Fresenius, Nestle, and Mead Johnson Nutrition. J.B. reports personal fees and nonfinancial support from AbbVie, Nutricia, Biocodex, personal fees from MSD, Nestlé, Ferring, Walmark, outside the submitted work. C.C. received research funding from ORDESA Laboratories, S.A. N.E. reports receipt of grants/research supports from National Institutes for Health Research (UK), Prolacta Bioscience (US) and Danone Early life Nutrition. He also served as member of Advisory board for Danone Early life Nutrition and received payment/honorarium for lectures from Danone Early life Nutrition, Nestle Nutrition Institute, Baxter and Fresenius Kabi. M.F. receives research funding from Philips and has received honoraria for lectures from the Nestle Nutrition Institute and for co-editing a book chapter on growth from Danone Early Life Nutrition. K.G. reports personal fees from Nutricia, research grants and personal fees from Nestle, and Nutricia and personal fees from Dr Falk. I.H. reports receipt of payment/honorarium for lectures BioGaia, Nutricia, Nestle, GM pharma, and of payment/honorarium for consultation Farmas, Chr Hansen. F.I. reports receipt of payment /honorarium for lectures Biogaia, Nestle, Danone, Abbot. Consultant for Biogaia. S.J.M. reports receipt of grants/research supports from DSM Nutritional Products, she served as member of advisory board and received payment/honorarium for consultation from Baxter and received payment/honorarium for lectures from Baxter and Fresenius Kabi. E.V. reports grant/research support from Nutricia Italia Spa, Nestle Health Science—Vitaflo Italy, FoodAR srl Italy, PIAM Pharma, and Integrative Care. M.D. reports a research grant from Baxter and speaker fees from Semper, Baxter, Nutricia, and Abbvie. The remaining authors (N.F.M., J.H., and C.M.) report no conflicts of interest.

Disclaimer: ESPGHAN is not responsible for the practices of physicians and provides guidelines and position papers as indicators of best practice only. Diagnosis and treatment is at the discretion of physicians.

The authors report no conflicts of interest

© 2019 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,