With the establishment and improvement of perinatal medical centers and the significant increase in the treatment capacity and treatment rate of premature infants, more preemies are able to survive birth. How should we scientifically care for and feed them?

Inadequate nutritional intake in early life will affect the baby's physical and nervous system development, while too much nutrition will increase the incidence of adulthood diabetes, obesity, metabolic syndrome and other chronic diseases. Therefore, feeding matters a lot for preemies.

I. What to feed

Breast milk, especially colostrum, which is known as "liquid gold" and "white blood", is rich in nutrients, immune factors, DHA and more. It can help a baby's growth and enhance a baby's immunity, making it the first choice for feeding preemies.

For preemies with a gestational age of >34 weeks and a birth weight of more than 2 kilograms, they can be fed with breast milk. For those with a gestational age of <34 weeks and a birth weight less than 2 kg, it is recommended to add enhancers to breast milk to ensure their nutritional needs.

The amount of enhancers added to breast milk should be customized and adjusted according to the results of regular monitoring of the physical development of preemies. The length of time enhancers are used should also be adjusted and monitored.

For preemies who cannot be breastfed, transitional formula milk powder is recommended to meet their nutritional needs. While formulas for special medical purposes such as lactose-removed formula, hydrolyzed protein formula and amino acid formula should be used under the guidance of doctors.

II. How to feed

Bottle feeding can be undertaken in the early stage and then breastfeeding is recommended. When feeding, try to dim the light, lower the sound and reduce interference. Feeding intervals of two hours and three hours are both acceptable and appropriate adjustments could be made according to the baby's condition.

There are three recommended breastfeeding positions, namely the cradle pose, the embracing pose and the horizontal pose. The embracing pose is recommended for preemies.

III. How to supplement vitamin A and vitamin D

Both fat-soluble vitamins and water-soluble vitamins in breast milk are insufficient to meet the growth needs of preemies, especially vitamin A and vitamin D. According to the guidelines, premature and low-birth-weight infants should be supplemented with 800-1,000U/day of vitamin D after birth and 400U/day from 3 months of age until they are 2 years old. In 2016, the European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) recommended preemies receive a vitamin A dose of 700-1,500IU/kg/day.

IV. Recognition and handling of special circumstances

1. Baby's feces

The feces of breastfed babies should be a yellow or golden yellow mostly uniform paste that isn't smelly. It may also have a few yellow fecal particles, or be thinner and green. Babies should eject feces two to four times a day on average. 

The feces of babies fed with milk powder should be mostly light yellow or grayish yellow, relatively dry and thick. This feces should have an obvious odor caused by protein decomposition, sometimes mixed with white clots. Babies should defecate one to two times per day, and constipation can easily occur.

If a baby passes a lot of watery feces – or feces that contains mucus or even blood – each day, you need to immediately take the baby to the hospital.

2. Infant reflux and choking on milk

Newborns are prone to reflux due to their special physiological structure. After breastfeeding, a baby's head should be raised 30 degrees and the newborn should be placed on its side in a lying position. After half an hour, it should be moved to the supine position. Preemies should not sleep in the prone position, which may increase the risk of sudden infant death syndrome (SIDS). When vomiting a lot of milk, you can turn your baby's head to one side to avoid choking.

Preemies have uncoordinated sucking and swallowing functions and are prone to choking. First of all, the feeding posture must be correct. The baby should be reclining in the mother's arms and babies should not be fed on the bed. 

Slight choking usually won't cause milk to enter the respiratory tract, and babies can usually adjust themselves. If the baby does not breathe or has a cyanotic complexion, hold the baby upright or put the baby facedown on its mother's lap and pat its back to encourage it to cough up the blockage. If severe choking occurs and the baby cannot breathe, the parents should immediately get the infant to a medical facility.

V. Growth assessment and milk formula adjustment

The early stage is the golden period for preemies to catch up with their growth, so mothers should pay close attention. Parents should follow doctors' advice on feeding after going home from the hospital and their baby should receive regular care. Doctors will assess the baby's growth status according to weight, head circumference, length and growth rate, and individually adjust the baby's feeding plans.