Nutrition of premature babies - how to choose and calculate the amount of the mixture. Nutrition of premature babies (Need for human milk) Calculation of nutrition of premature babies

Features of feeding premature babies are associated, on the one hand, with the immaturity of the gastrointestinal tract and low enzymatic activity, and on the other hand, with an increased need for nutrients, vitamins and microelements, because the baby needs strength to grow and get stronger. The ability depends on the degree of its maturity.

Deeply premature babies weighing up to 1500 grams and born at 29 cannot suck and swallow on their own, because they are fed through a tube. These babies usually begin to suckle or bottle by the end of the first month of life. Children weighing 1500-2000 grams (II degree of prematurity - 32-34 weeks) can independently receive bottle feeding or suckle. But often these babies do not have enough strength to suckle at the breast, and at first they are bottle-fed with expressed milk or formula, and then gradually they try to switch to exclusive breastfeeding. Babies with I degree of prematurity, born at 35 with a weight of 2000-2500 grams, may well suckle and develop well.

Since the acidity of the gastric juice is reduced, delayed intestinal peristalsis, dysbiosis, then during this period they need to be fed exclusively either breast milk or specially adapted formulas for preterm infants, they usually have the word Pre in their name. Studies of breast milk of mothers of premature babies showed that depending on the degree of prematurity, their milk composition changed. In this milk, the content of proteins, which are so necessary for the enhanced growth of the baby, as a building material, is increased, the content of essential amino acids is increased, a higher degree of fat content, the breakdown of which does not require additional energy costs. In addition, mother's milk contains prebiotic substances that promote the growth of beneficial intestinal microflora, antibodies to various infections, which are especially susceptible to premature babies, enzymes that improve the absorption of milk. The energy value of “premature” milk is higher than that of “full-term”. Therefore, a woman should make every effort to preserve milk and eventually establish full breastfeeding.

Although, with all the desire to feed, many women who have had premature births have hypogalactia, that is, a lack or absence of breast milk. That's why from the first days, the mother should express milk and try to let the baby suckle. Due to their weakness, babies often suck hard at the breast. If you see that the baby is tired, he has a blue around his mouth, then stop feeding and supplement with expressed milk from a bottle. Usually, by the 2nd - 4th week, children are getting stronger and are already able to switch to pure breastfeeding. In order not to lose milk, be sure to pump every 3 hours, including at night, and after each feeding.

To prevent aspiration, the first feeding of a premature baby is carried out 3-6 hours after birth with sterile water. In the future, the child begins to receive a 5% glucose solution and already from 5-6 feedings (premature babies of I-II degrees of prematurity) he is transferred to breast milk and a special milk formula. Babies with a deep degree of prematurity are transferred to breast milk only 18-36 hours. Babies are fed every 3 hours, with more frequent feedings (every 2 hours) the amount of food received is carefully calculated so as not to overload the infant's immature gastrointestinal tract. With a deep degree of prematurity (IV degree), sick children receive continuous nutrition through a probe, like a dropper. If the baby spits up or for other reasons cannot receive nutrition through the mouth, then nutrient solutions are administered to him intravenously - parenteral nutrition.

If the baby cannot receive breast milk for any reason, then it is fed with a special mixture., which does not change until it reaches a weight of 4-5 kg. This mixture has a balanced composition of proteins, fats and carbohydrates for premature babies, contains an increased amount of taurine for the development of the brain, calcium and phosphorus, necessary for the mineralization of the skeleton and bones of the child, vitamins and other trace elements, prebiotics and probiotics to prevent the development of intestinal dysbacteriosis.

The calculation of the amount of mixture or breast milk is carried out based on the caloric needs of a small organism. On the first day, the child receives 5 ml of the mixture (nutrient solution) in one feeding, the amount increases to 15-20 ml by the 3rd day of life. Further, the diet is calculated based on the daily norm for premature babies 130-140 kcal per 1 kg of weight (for full-term babies, this figure is 115 kcal). The calorie content of breast milk is 70 kcal per 100 ml, and the mixture - 80 kcal per 100 ml.

Premature babies are especially prone to rickets, anemia. Therefore, even if the baby is breastfed, from the first month (from 2-3 weeks) he needs an additional intake of vitamin D in the form of special drops. Also, these babies have very meager iron stores in the body, which are usually depleted by the 1st month. In breast milk, iron is not enough for children, despite the fact that it is very well absorbed from it, therefore, the doctor, having assessed the condition of the baby, may decide on additional intake of iron-containing drugs.

The first complementary foods for premature babies are usually introduced earlier at 4-4.5 months.. To prevent the development of anemia and rickets, premature babies are given fruit and vegetable juices, puree, meat, and yolk earlier than full-term babies. Complementary foods in the form of porridge are also important for a premature baby, as it helps him quickly gain the weight he needs for his age. Monitoring the effectiveness of feeding a premature baby and the state of his health should be carried out only by a doctor, who, depending on the child, will change or supplement the diet.

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Premature babies require special and more thorough care than babies with normal weight. A premature baby is a baby who was born before 37-38 weeks of pregnancy and weighs less than 2.5 kilograms. These children are characterized by thin skin and reddish wrinkled skin, lethargy and decreased muscle tone, inactivity and slow weight gain.

Often early toddlers begin later to master various skills and abilities. Therefore, such crumbs can lag behind in development by 1.5-4 months. However, with proper care and nutrition, regular supervision by a doctor, the child will soon catch up with their peers. Subject to the recommendations, the baby's condition will approach normal by the year. In this article, we will look at the rules for the care and feeding of premature newborns.

Rules for caring for premature babies

• Children born prematurely are often characterized by a weak development of swallowing and sucking reflexes, therefore, in the first weeks of life, the baby may be prescribed feeding through a tube;
• After the birth of a premature baby, they are not immediately applied to the breast, but examined and placed in an incubator with automatic oxygen supply and maintaining optimal conditions for the child's life;
• Try, because mother's milk is the best food and medicine. It strengthens the immune system and promotes weight gain, gives strength and accelerates the development of the baby;
• If so far nutrition is only through a tube or a bottle, regularly offer the baby the breast to develop the compositive-swallowing reflex;
• Create comfortable conditions for babies in the nursery. Suitable room temperature for premature and small babies is 22-25 degrees Celsius;
• You can bathe a child weighing less than 1.5 kg only after two to three weeks from the moment of birth. In other cases, bathing is allowed already for 7-10 days. At the same time, a suitable water temperature is 38 degrees above zero, and the air temperature in the bathroom is at least + 25 ° C;
• You can start walking with a baby only in warm weather 1.5-2 weeks after birth. The first walk should be short and take no more than ten minutes. Gradually increase the time spent in the air up to 1.5 hours. It is not recommended to walk with a premature baby in the heat or cold;
• The doctor draws up an individual vaccination schedule and makes a personal calculation of the nutrition of premature babies, depending on the weight, height and developmental features of the baby;
• Massage is an invaluable benefit in the development of a small baby. More than half of these children begin to gain weight faster. In addition, this procedure strengthens the muscles and immunity, promotes the development of reflexes and improves the physical condition of the child. However, it is important that the massage is performed by a professional;
• Before starting a massage or gymnastics, be sure to consult your doctor! Massage can be introduced already in the second week of life, and special gymnastics after 1-1.5 months from the moment of birth;
• If the baby weighs less than two kilograms, it is important to dress the child warmer. With a higher body weight, the baby is dressed in the same way as children born at term. How to dress a newborn, read.

Features of nutrition of premature babies

Features of feeding premature babies are due to the fact that such babies have a poorly developed digestive system, sucking and swallowing reflex. In no case should you overfeed the baby, trying to reach the desired weight! This can seriously harm the digestive system and cause severe intoxication.

To control the nutrition of the newborn, it is recommended to regularly weigh the crumbs and carefully measure the amount of food. For convenience, you can keep a food diary of a premature baby for months. It is important to establish a comfortable feeding regimen and follow the recommendations.

Modern pediatricians are advised to introduce feeding for babies on demand, and not according to the regimen. However, this is quite difficult for premature babies, since such babies sleep most of the time and do not express a desire to eat. In this case, it is recommended to combine modes on demand and on mode. It is important that there are no long intervals between feedings. But don't force feed your baby!

In addition to the basic nutrition, the doctor may recommend the inclusion of additional vitamins in the child's diet. In the first three days of life, vitamins C and K are needed, after two to three weeks - vitamin D. In addition, it is important for a premature baby to take iron. These useful elements can be included in special medical nutrition or administered separately.

Norm and frequency of feeding

In the first two weeks of life, the daily food intake for the baby is calculated using the Rommel formula. For every hundred grams of body weight, there are 10 ml of milk or mixture, to which you need to add the number of days the baby lives.

For example, to determine the amount of food for a week-old newborn weighing 2 kg, we use the following calculations: 10 ml + 7 (days of a child's life) - 17 ml for every 100 grams. Thus, for 2000 gr 17 * 20 and we get 340 ml.

Artificial feeding and milk formulas

If a nursing mother for some reason cannot feed her baby with breast milk, you need to choose the right milk formula. It should be high-quality and suitable nutrition with the necessary set of vitamins and nutrients. When choosing a mixture, it is important to take into account all the characteristics of the child, including premature birth, weight and height, age, reaction to certain components.

Choose specially adapted milk formulas for premature or small babies. Such compositions are distinguished by increased energy value and increased calorie content, which contributes to rapid weight gain. This saturates the child with energy and gives strength.

Adapted formulas for premature or small babies often contain calcium and phosphorus, which strengthen bones and teeth, promote growth and weight gain. In addition, the composition includes a high protein content, fast-digesting carbohydrates, various vitamins, macro- and microelements. The mixtures include nucleotides for the normal functioning of digestion and the formation of a healthy intestinal microflora, as well as polyunsaturated fatty acids for mental abilities and the full functioning of nerve cells.

Tube feeding

Feeding a premature baby through a tube is carried out if the baby was born before 33-34 weeks. The doctor prescribes this method of nutrition with deep or extreme immaturity, when there is no sucking-swallowing reflex, with a critical condition of the child after birth, and with abnormal development of the nasopharynx.

When feeding through a tube, it is important to observe sterility. The installation of the device is carried out by professional doctors. As a rule, it serves three days, after which it is replaced. When the probe is inserted, the baby is fed with warmed milk or a mixture with a temperature of up to 40 degrees drip through a syringe. The process is carried out under the strict supervision of a physician.

This method is fed until the child's condition stabilizes. When the baby has a sucking and swallowing reflex, and he gains weight, you can switch to normal nutrition. It is important that babies do not experience nausea and vomiting, profuse regurgitation and bloating. To determine the sucking-swallowing reflex, periodically put the baby to the breast or put a bottle with a nipple to the mouth.

Introduction of complementary foods for premature babies

You need to feed a premature baby a little differently than babies born at term. In this case, the first feeding begins at 5-6 months with 5% buckwheat porridge, and not with vegetable purees. Do not start feeding the baby if he is sick and feels unwell, during the period of active teething, with severe colic and problems with the tummy!

The first cereals are cooked in water or vegetable broth in a ratio of 5 grams of cereal per 100 ml of water. A few drops of breast milk or milk formula are added to the dish, then they gradually switch to 7.8 and 10% porridge. After buckwheat, rice is introduced and sunflower or olive oil is added to the porridge. It is not recommended to switch to milk porridge earlier than eight months.

At the age of six months, include vegetable puree from cauliflower and broccoli, potatoes and zucchini. At the eighth month, the baby is given meat puree from rabbit and turkey, then chicken and mashed egg yolk are included.

At the age of eight months, they also begin to give complementary foods in the form of fruit and vegetable juices. The main juice is apple, you can also give crumbs drinks from pears, cherries and black currants, carrot juice is introduced a little later. By the ninth month, baby biscuits and vegetable soup can be given.

The table below will tell you about the timing of the introduction and volume of food in complementary foods for a premature baby.

Introduce each new product gradually and carefully. For the first time, let's try the crumbs no more than half a teaspoon, and then wait two days. If there are no negative consequences in the form of allergies, poisoning, indigestion or stools, the product can be included in the child's diet. You can find general rules for the introduction of complementary foods for infants at the link.

After the baby receives complementary foods, supplement it with breast milk. Do not stop breastfeeding until at least 8-9 months, but it is better to continue breastfeeding along with the introduction of complementary foods until 1.5-2 years. This improves the assimilation of new food and normalizes digestion, reduces the risk of poisoning and worsening of the stool. Milk continues to provide the necessary elements for the full development of the child, as it changes with the growth of the baby and adapts to his needs.

You can make sure that the baby gets the right amount of food using a special calculation of the nutrition of children in the first year of life. Formulas derived by experts will help in the calculations.
You can also use the general norms that will indicate the correct amount of food. If necessary, it can be adjusted so that the child grows up healthy and active.

Up to 10 days

At this age, the newborn is most often referred to the Finkelstein formula. With an initial body weight of a baby of 3 kg 200 g or less, a coefficient of 70 is set.

If he was born weighing more than 3 kg 200 g, a factor of 80 is used in the formula.

The amount of food is calculated by multiplying the coefficient by the number of days the baby lives.

An example of calculating the amount of food for a 5-day-old baby born with a weight of 4 kg: 80 must be multiplied by 5. The result is 400 ml.

To determine how many ml is needed in one feeding, we divide the daily rate by the number of meals.

An example for a 7-day-old baby who was born weighing 3 kg. Divide the daily rate (490 ml) by 7 (number of meals). It turns out 70 ml in one feeding.

Also, the volume of food can be determined by the formula of G. Zaitseva. This method is more often used for large children born with a weight of 4 kg. To determine the daily amount of food, the age of the child is multiplied with 2% of birth weight

For example Let's calculate the amount of food for an infant of 9 days of life with an initial weight of 4.5 kg. First, we determine 2% of body weight. We multiply 4500 by 2 and divide by 100. We get 90. Now we multiply 90 by 9. We get 810 ml per day.

Another formula suitable for this age was developed by N. Filatov. Here the calculations are based on the size of the stomach of the crumbs. At birth, it is 7 ml, at 4 days - 40 ml, at 10 days - 80 ml.

The formula calculates the amount for one feeding. The number of days a newborn lives is multiplied by 10.

10 days to a year

For a child 10 days old, you can calculate the daily allowance using a calorie or volumetric method. The first takes into account the caloric content of food. The second is calculated by the weight of the child.

Volumetric method

Used up to 9 months. Calculations depend on the body weight and age of the baby. The table will help:

From 9 to 12 months, the child should consume no more than one liter of food per day.

Example: let's take the data of a 5-month-old toddler, with a body weight of 6 kg. 6000 divided by 7, we get about 857 ml. With six feedings, the volume of food at a time will be 140 ml.

Caloric method

It is also called energy. Based on the calorie content of the food and the age of the child. The calculations here are more complicated, especially after supplementing the diet.

The easiest way to determine the daily volumes at. The average calorie content of 1 thousand ml of mother's milk is 700 kcal.

An infant of 1-3 months needs 120 kcal per kilogram of weight.
3-6 months - 115 per kilogram of weight.

Example for baby 2 months with a weight of 3700 gr. We multiply the energy norm 120 by 3.7, we get 444 kcal per day. Then we calculate how much it is in ml of breast milk.

We make a proportion based on the data on the calorie content of 1000 ml of human milk. We multiply 1000 by 444 and divide by 700. We get 634 ml. If the baby is on 6 meals a day, he needs about 105 ml of milk at a time.

It is also quite simple to determine the calorie content of food and the required volumes when feeding with mixtures. The data is always indicated on the packaging.

Let's calculate the norm for an artificial man of 6 months with a body weight of 7 kg:
We multiply the rate of 115 kcal by weight - 7. We get 805 kcal. Then we make a proportion, taking into account the calorie content of the mixture - 800 kcal per 1 liter. Multiply 1000 by 805 and divide by 680.

We get about 1180 ml per day. When eating 5 times a day, about 235 ml will be needed for one feeding.

Calculations become more difficult after enriching the menu with numerous innovations: vegetables, fruits, meat.

To calculate, you will need to know the calorie content of 100 grams of all these products.

General norms up to a year

If there is not enough data for your own calculations, you can use generally accepted standards. Of course, they do not take into account the characteristics of a particular baby, since they were developed by a volumetric method for children with an average weight.

For small children, they may be too large, and for large children, they may not be enough.

For children who were born large, as well as for those who are rapidly developing physically, their own nutritional standards have been developed.

premature babies

If the baby is premature, the calculations take into account the possibilities of digestion and the needs of the body. The fact is that the child needs more energy, and digestion has less capacity.

How many calories does a newborn need from the first day to 1 month:

When an infant whose birth weight was more than one and a half kilograms turns 2 months old, the calorie content of food is reduced by 5 kcal per kilogram of weight.

Children weighing from 1 to 1.5 kg at birth, up to 3 months, eat the same way as in 1 month. Then the norm is gradually reduced by 5-10 kcal per kilogram of weight.

In this case, it is important to take into account the well-being of the baby.

Caution and slowness are the hallmarks of premature infant nutrition.

If, with an increase in the caloric content of food, the baby felt bad, it is worth returning to the previous indicators. These children are fed up to 2 months 7-10 times a day.

When the baby has gained weight of 3 kg, you can proceed to six meals a day. After six months, the child is fed 5 times a day.

Norms for sick and small children

Underweight refers to those who had a weight of up to 2.5 kg at birth.

These include premature babies and those who simply missed the weight norm. WHO recommends the following norms at the age of 1 to 10 days. On the first day, babies need 60 ml of milk or formula for every kilogram of body weight.

Then the rate is gradually adjusted to 200 ml per kg of weight per day. To do this, the amount of food is increased daily by 20 ml.

Sick children are called babies whose weight exceeds 2.5 kg, but because of some ailments, breastfeeding is prohibited for them. For this category, 150 ml of the mixture per day for each kg of weight is recommended.

How many feedings per day

Pediatricians and experienced mothers sometimes advise contradictory feeding regimens for babies.

How to choose the optimal number of meals for an infant?

• Up to 1 month, it is better to feed the baby on demand, but not more than 10 times.
• At the age of 1 to 3 months, the baby should eat an average of 7 times.
• At 3-4 months, you can feed him 6 times a day.
• From 4 months - 5 times.

How to understand that the child is full

He himself will help to reinforce confidence in the correct amount of nutrition for the baby.

There are a number of signs that prove satiety crumbs:

• active behavior and good sleep;
• regular chair;
• stable weight gain;
• smooth pink skin;
• the baby does not ask for food between feedings;
• urinates at least 12 times a day;
• releases the breast or bottle on its own when it is full.

If the baby rushes to the breast or other food greedily, he may not have had enough in the last feeding.

Amount while breastfeeding

Once born, the baby feeds on colostrum. Only on the 2-4th day does the first rush of milk occur. But the baby is not hungry until he appears.

Even the minimum amount of colostrum (for the first day it is no more than 100 ml) is enough for the baby to get enough.

On the second day, the baby already consumes 200-250 ml. Then daily the volume of food increases by about 10 ml. If there is concern that the baby is not eating up the daily allowance, you can weigh him before and after feeding.

It will become clear how much milk he drank.

When fed with mixtures

When formula feeding, it is easy to determine the amount of food eaten. However, it is worth considering certain recommendations:

• the average number of meals should be 8;
• if you feed less often, increase the volume of the mixture;
• it is important that the baby does not overeat;
• if he did not finish the norm, increase the portion at the next meal;
• between day feedings should be at least 3 hours, between night feedings - at least 6 hours.

If the baby does not eat regularly, he will not gain enough weight (less than 0.5 kg per month), he will be tearful, the number of urination will decrease (less than 12 times a day).

If, on the contrary, he overeats, certain signs will indicate this: frequent regurgitation, excess body weight, cramps after eating.

It is important to correctly compose the diet and nutrition of the crumbs so that the food is well absorbed and brings him only benefit.

Optimal nutrition in preterm infants remains a complex and largely unresolved problem. There are different points of view both in relation to feeding methods and in assessing the need for preterm infants of various gestational ages in basic nutrients and energy. Ultimately, the successful nursing of a premature baby largely depends on the doctor's ability to correctly assess his condition and provide vital nutrition in an accessible form.
Certain difficulties in feeding premature babies are caused by the following features of an immature organism:
- Decreased or absent reflexes of sucking and swallowing;
- small volume of the stomach and slow evacuation of its contents;
- reduced intestinal peristalsis;
- reduced enzymatic activity of the gastrointestinal tract (mainly lipotropic enzymes and lactase);
- a significant limitation of the reserves of all nutrients.
Complicating the task is the contradiction between the relatively high need of premature babies for nutrients and energy and the limited ability to obtain and assimilate them.
TERMS AND METHODS OF FEEDING
The time of the first feeding is associated with the degree of maturity of the child and his condition. Regardless of the chosen method, it is desirable to start the first feeding within 2-3 hours after the birth of the child, but no later than 6-8 hours. Sharply limited nutrient reserves, especially in very preterm infants, do not allow for delayed feeding tactics. In the absence of the possibility of enteral feeding, parenteral nutrition (PN) is prescribed.
Children weighing more than 2000 g, who are in a relatively satisfactory condition, can be attached to the breast in the first minutes after birth. However, it is necessary to carefully monitor the appearance of signs of fatigue in the form of cyanosis of the nasolabial triangle, shortness of breath, etc. If these symptoms occur, the number of breastfeedings is limited. For an immature baby, mother's milk is even more necessary than for full-term babies. Therefore, the doctor's efforts here should be aimed at maintaining breastfeeding. However, one should be very careful about the free regimen of feeding a premature baby ("on demand"), which is now recommended for feeding mature children. Weakened children, as well as newborns with perinatal pathology of the nervous system, in most cases are unable to regulate the volume of incoming milk, and therefore they are assigned fixed feeding hours.
Children with a body weight of 1500-2000 g in the absence of severe pathology (symptoms of cerebrovascular accident of II-III degree, respiratory distress syndrome, etc.) are given trial feeding from a bottle. In a serious condition, the child is fed through a tube or PP (full or partial) is prescribed.
Deeply premature babies weighing 1000-1500 g are usually fed through a tube. In case of poor tolerance of enteral nutrition, PP is additionally or in full.
Of particular difficulty is the feeding of very premature babies born with a very low body weight - less than 1000 g and a gestational age of 25-28 weeks. These children usually need a combination of enteral and parenteral nutrition. Moreover, the share of each of the methods of nutrition in the total volume should be selected strictly individually. So, in particular, in children at risk for the development of necrotizing ulcerative enterocolitis, preference should be given to PP. Regardless of the gestational age of the newborn and his body weight, complete PN is prescribed only in a very serious condition of the child, as well as in ulcerative necrotizing enterocolitis, some anomalies in the development of the gastrointestinal tract in the pre- and postoperative period. At the first opportunity (stabilization of the state, tendency to improvement), it is necessary to introduce at least a minimal amount of enteral nutrition with great care.
Many neonatologists consider it unphysiological to completely deprive even a very immature or extremely heavy child of enteral nutrition. There is a concept of "minimum enteral nutrition" during complete PN. As a result of the introduction of small volumes of milk (4-8 ml / kg per day), the release of intestinal hormones is stimulated, its motility improves, the intestinal wall does not suffer, which contributes to the normal development and full authorization of the gastrointestinal tract in the future.
If an immature baby tolerates breastfeeding well or sucks out the norm from a bottle, then usually a 7 or 8-time feeding regimen is set for him (every 2.5-3 hours with a 4-6 hour night break).
If necessary (body weight less than 1500 g, severity of symptoms of depression of the central nervous system), premature babies are fed in portions (7-10 times a day) through a nasogastric tube. In these cases, a soft, non-traumatic catheter is used, which is inserted through the nose to a length equal to the distance from the bridge of the nose to the xiphoid process of the sternum.
After inserting the probe, lower its free end into the water to make sure that the probe is in the correct position (no air bubbles). Next, the probe is fixed on the child's cheek with a band-aid. A small amount of water is introduced through the tube, since aspiration of glucose leads to the same negative consequences as aspiration of milk. After the introduction of water, you can start feeding.
Every 2 days, the probe is changed with its introduction into the other half of the nose. The probe should be removed some time after feeding and must be pinched. With enteral tube feeding, it is necessary to periodically control the passage of milk, checking the remains of it and the stomach before the next feeding. If the residual amount of milk is small (no more than 10% of the entered), the volume of feeding is not changed, and after removing the aspirate, the required amount of milk is introduced. If more than 10% of the injected milk remains in the stomach before the next feeding, the feeding pattern should be changed, reducing the volume and increasing the frequency of feeding, or switching to a constant tube infusion.
Continuous tube feeding is indicated for children weighing less than 1300-1200 g, as well as larger newborns with various disorders of the passage of milk through the gastrointestinal tract. It is carried out using syringe infusion pumps. The required amount of milk (5% glucose solution) is drawn into the syringe, using an adapter, the syringe is connected to the child's probe, after which the required injection rate is set. There are several modes of long-term tube infusion: milk can be administered around the clock or come at certain intervals followed by breaks. The most common is the introduction of milk within 3 hours with a break of 1 hour and a 5-hour night interval. Thus, 5 infusions are carried out per day. The initial rate of introduction of milk is 1.5-3 ml/kg per hour. By the 6-7th day, it gradually increases to 7-9 ml/kg per hour.
The use of this method in very premature babies allows them to provide them with a large amount of nutrients and energy, which reduces the catabolic orientation of metabolic processes in the first days of a child's life. In addition, the functional activity of the gastrointestinal tract improves, congestion decreases (the intensity and duration of hyperbilirubinemia decrease), and the frequency of vomiting and respiratory disorders associated with feeding decreases.
When carrying out the method of long-term infusion through a paeogastric tube, the infusion pump must be below the child, since otherwise the smallest particles of milk fat will rise up and remain at the base of the syringe and in the adapter, which leads to a loss of up to 33% of the calorie content of milk. It is desirable that the adapter is located in the incubator where the child is placed, then the milk will flow into the probe warm. Milk should not be exposed to light for a long time during phototherapy, as this destroys a number of vitamins.
After the child's condition improves, the sucking reflex is activated, he should be transferred to portioned bottle feeding, and then begin to apply the baby to the breast. In order to stimulate sucking, you can use the "kangaroo" method, which has become widespread in neonatal clinics both abroad and in our country. The method can be applied when nursing very premature babies. Its essence lies in the fact that the mother puts the naked child on her bare chest, placing it vertically in the hollow between the mammary glands. The warmth of the mother's body and close contact with the mother have a calming effect on the baby and at the same time stimulate the sucking reflex. At the same time, the mother's milk production increases.
If enteral feeding is not possible, parenteral nutrition is prescribed from the first day of the child's life. At the same time, a 10% glucose solution is administered intravenously at a rate of 4-5 mg / kg per minute (6-8 g / kg / day). Gradually, the concentration of glucose solutions can be increased under the control of blood glucose levels. The maximum dose of glucose is 11-12 mg/kg/minute (16-18 g/kg/day). From the 2nd day of life, amino acid solutions are administered at a dose of 0.5-1.0 g/kg/day with a gradual increase to 3.0 g/kg/day. Also, from the 2-3rd day of life, the introduction of fat emulsions at a dose of 0.5 g/kg/day is started, gradually increasing the dose to 2-2.5 g/kg/day. The infusion is carried out within 20-24 hours in the absence or after the correction of gross metabolic disorders. As the child's condition improves, a minimal enteral administration of milk is prescribed by the method of constant tube infusion.
In table. 1 shows a tentative scheme for the implementation of complete PN in children weighing less than 2500 g.
The scheme of parenteral nutrition
premature babies (number of solutions, ml/kg/day)
Table 1

During the period of parenteral nutrition, daily monitoring of the acid-base state of the blood, the level of basic electrolytes, glucose, urea, measurement of diuresis is necessary. The tactics of PP is determined by the clinical condition of the child, the ability to retain and assimilate enteral nutrition, the presence or absence of metabolic disorders.
It should be emphasized that the choice of one or another way and method of feeding depends mainly on the condition of the child. In some situations, a child weighing 2000 g or more is born in a very serious condition and receives parenteral nutrition, and a child weighing 1300 g retains milk well with fractional feeding and even tries to suck on his own.
REQUIREMENTS OF PREMATURE CHILDREN FOR BASIC NUTRIENTS AND ENERGY
In addition to the condition of the child, his need for basic nutrients and energy is a guideline in the appointment of feeding. A premature baby is born with a limited supply of nutrients. For example, the proportion of adipose tissue in a newborn weighing 3500 g is 16%, in a newborn weighing 1500 g - 3%, and in a newborn weighing 800 g - 1%. In a fetus at 20 weeks, the total amount of protein is 15 g, and at 40 weeks - 500 g. During the third trimester of pregnancy, the fetus normally receives 75-80% of the total amount of calcium, phosphorus, iron, copper. Providing prematurely born children with sufficient nutrients and energy is limited by the physiological and biochemical immaturity of the body, as well as various pathological conditions of the early neonatal period (impaired hemolytic dynamics, respiratory disorders with frequent apnea, infectious and inflammatory diseases, etc.).
It is necessary to constantly monitor the adequacy of feeding a premature baby. For this purpose, daily calculation of nutrition by the "calorie method" is made. Other calculation methods may be inaccurate, as they are only approximate.
The energy needs of premature babies are on the 1st day of life - 25-30 kcal / kg, on the 2nd day - 40 kcal / kg, on the 3rd day - 50 kcal / kg, on the 4th day - 60 kcal / kg, in the 5th day - 70 kcal / kg, in the 6th - 80 kcal / kg, in the 10th - 100 kcal / kg, by the 12th day this need increases to 110 kcal / kg, by the 17th - up to 130 kcal / kg, and by the end of the 1st month of life - up to 135-140 kcal / kg.
With artificial feeding, the calorie content of a premature baby should not exceed 130 kcal / kg.
When calculating the daily volume of milk, the child's body weight is multiplied by the calorie content of the diet and divided by the calorie content of milk (700 kcal / l). For example, a child weighing 2000 g on the fourth day of life should receive:

2000 * 60
V = -------------------- x 170 ml / day.
700

In premature infants with a birth weight of more than 1500 g in the 2nd month of life, the calorie content of the diet is reduced by 5 kcal/kg. In very premature babies (body weight less than 1500 g), caloric content is reduced only after three months of age, gradually, over 2-3 months, bringing it to the norms adopted for full-term children (115 kcal / kg). This takes into account the nature of the weight curve and the general condition of the child.
After calculating the amount of food by the caloric method, it is necessary to determine the amount of protein that a child will receive with such a diet. This figure should not exceed 4 g / kg / day.
On average, the need for protein in premature babies is 2.5-3.8 g/kg/day. These values ​​are determined for natural feeding.
With artificial and mixed feeding of children with modern adapted mixtures intended for premature babies, the need for protein remains the same, given the high bioavailability of the protein they contain.
The need for fat in premature babies is about 6.5 g/kg/day in the first half of life and 6 g/kg/day in the second half of the year.
The need for carbohydrates throughout the first year of life is 12-14 g / kg / day.
The need for fluid in the first week of life in children weighing less than 1500 g is 90-140 ml / kg / day (taking into account the liquid contained in breast milk), in children weighing more than 1500 g - 70-130 ml / kg / day During the first month of life, this figure increases to 150-200 ml/kg/day.
It must be remembered that a breastfed premature baby requires additional fluid (water, 5% glucose solution) in a volume approximately equal to the volume of one feeding.
The need for vitamins in premature babies is high. Since women's milk is deficient in a number of vitamins and microelements, it is advisable for nursing mothers to prescribe vitamin-microelement complexes. Regardless of the type of feeding (natural or artificial), a premature baby is recommended to additionally prescribe vitamin D from the 14-30th day of life.
NATURAL AND ARTIFICIAL FEEDING OF PREMATURE CHILDREN
In recent years, more and more new data have appeared about the unique properties of breast milk, which allow us to consider it as a living tissue of the human body. It contains living cells (macrophages, polymorphonuclear leukocytes, T- and B-lymphocytes), as well as a wide range of biologically active factors, such as antimicrobial and antiviral (immunoglobulin A, lactoferrin, lysozyme, folate-binding proteins, complement), a significant amount of hormones and growth factors, as well as at least 60 different enzymes.
The milk of women who gave birth prematurely has a higher energy value. It has a higher concentration of protein and, in some cases, fat, but lower lactose content with the same level of total carbohydrates. Such a composition largely meets the needs of premature babies and is consistent with the characteristics of their body.
However, a comparison of the needs of premature babies, especially very premature babies, with data on the composition of breast milk allows us to conclude that it does not fully meet the needs of these children in protein, energy, for example, calcium, phosphorus, magnesium, zinc and vitamins B2, B6, C, D, E, K and folic acid. In addition, underweight babies often cannot be breastfed by their mothers; expressed mother's or donor breast milk must be used. Heat treatment of milk significantly reduces the activity of antimicrobial factors, contributes to the denaturation of lipase and the destruction of milk cells, thus reducing its biological properties. Proteins and fats are less well absorbed from pasteurized milk.
Therefore, the most optimal type of feeding of premature babies is mother's milk, enriched with specially designed protein-mineral-vitamin supplements - the so-called "women's milk enhancers".
These "amplifiers" include "Pre-Samp" ("Samper", Sweden), "S-26/SMA HMF" ("White", USA), "FM-85" ("Nestlé", Switzerland), etc. These supplements contain protein of high biological value, a wide range of water- and fat-soluble vitamins, basic macro- and microelements.
Supplements are dissolved in expressed breast milk immediately before each feeding of the child at the rate of 1 serving of powder (approximately 2 g) per 50-100 ml of milk (in accordance with the label).
In the absence of these additives, specially designed mixtures can be used, such as Humana O, Enfalak, Nenatal, Alprem, Frisopre, etc. Their introduction into the diet of a child receiving breast milk, in the amount of 1/5 -1/3 of the daily amount of food allows you to more fully meet the needs of premature babies in protein, energy, minerals, vitamins. For the same purpose, it is possible to use products based on whey protein hydrolyzate (Alfa-Re, Pepti-Junior, Peptidi-Tutteli, Frisopep).
With a lack or absence of human milk, specialized mixtures are prescribed for premature babies. The selected mixture is administered starting from 5-10 ml 2-3 times a day, gradually increasing its amount.
When a child reaches a body weight of 2500-3000 g, he is gradually transferred from a specialized mixture intended for premature babies to conventional substitutes for women's milk. However, formulas containing more than half of the protein component casein should be avoided as this leads to an unfavorable increase in plasma levels of toxic aromatic amino acids.
In table. 2 provides information on the chemical composition and energy value of adapted mixtures for mixed and artificial feeding of premature babies.
Chemical composition and energy value of mixtures for feeding premature babies (in 100 ml of the finished mixture)
table 2

* - the mixture can be prepared in two dilutions.

If the child has regurgitation, as well as a tendency to constipation, it is possible to prescribe the therapeutic mixture "Frisovoy" in amounts that make up 1/4-1/2 of the daily volume of food.
COMPLETE FOOD INTRODUCTION
From 4-5 months of age, depending on the availability of mother's milk and an increase in body weight, they begin complementary foods in the form of vegetable puree or porridge. Porridges should be preferred if the child has malnutrition, as well as iron deficiency anemia (industrial cereals enriched with iron), intestinal dysbacteriosis, accompanied by liquefied stools, lactase deficiency. In the first half of life, mainly gluten-free cereals are introduced.
If porridge is used as the first complementary food, then vegetable puree is the second food, which is introduced after 2-4 weeks. Simultaneously with vegetable puree, vegetable oil is prescribed, and a little later - meat puree.
Curd should be used after 6 months of age. To correct the protein component in the diet of children in the first half of life, milk protein hydrolysates are prescribed. The increased content of easily digestible protein in them, as well as the presence of a vitamin-mineral complex, provide them with a significant advantage over cottage cheese. From 6-7 months of age, a hard-boiled egg yolk is introduced. The third complementary foods in the form of fermented milk products are recommended from 8-9 months.
When monitoring a premature baby, strict control over its physical development is necessary. For a correct assessment of the pace of physical development of premature babies, one should focus on the approximate average daily rates of weight gain in a premature baby. So, in the 1st and 2nd months of life, 10-15 g per 1 kg of a child's body weight at birth can be considered an adequate daily increase. For example, the daily weight gain of children born with a body weight of 1000 g is from 10 to 15 g, those born with a body weight of 1500 g - from 15 to 22.5 g (10 g x 1.5 = = 15 g, 15 g x 1.5 \u003d 22.5 g), and in children with a birth weight of 2000 g, this figure will already be from 20 to 30 g.
Accordingly, the normal weight gain for the 1st month of life in children of the first group will vary within 300-450 g, the second group - 450-675 g, the third group - 600-900 g.
Approximately the same rate of increase in body weight persists in the 2nd month of life.
In the future, when assessing the state of physical development of premature babies, one can roughly focus on the average monthly weight gain of a full-term baby, which is 800 g at the 3rd month of life, 750 g at the 4th month, 700 g at the 5th month, etc. d.
However, it should be borne in mind that very premature babies at the 5-7th month of life may have higher rates of development.

The normal period of pregnancy is nine months, and the estimated time of birth of the baby is from 37 to 42 weeks. But not everyone is born on time. There are many reasons for this, including adverse environmental factors. A baby born before the 37th week of pregnancy is considered premature. Concern for his health, development, growth and nutrition requires increased attention from parents and medical staff.

Premature babies are underweight. But, as a rule, over time, they move into a phase of active growth and catch up with their peers. This process requires an intensive supply of energy to the body. However, the digestive system in premature babies is not fully developed, some of its abilities are limited, and reflexes associated with food intake, such as sucking or swallowing, are often weakly expressed.

The mode and composition of nutrition for each premature baby is assigned strictly individually. This takes into account the initial weight of the newborn. A baby with a body weight of up to 1.5 kg in development is significantly different from a two-kilogram one, which will also affect nutrition. At first, it will be parenteral (nutrients are administered intravenously), because the baby still does not know how to eat on its own.

Important first feeding

The baby was born premature. When is he fed? Here you need to focus on the general condition of the crumbs. If the condition is assessed by experts as normal, the first feeding begins after a few hours. As long as the baby is able to suckle. Here, the time may vary, but, according to the recommendations of doctors, it should not exceed a day from the moment of birth.

But if the child has hypoxia, it is necessary to extend the "hungry" period. Premature babies are also often given an intravenous glucose solution (a form of parenteral nutrition).

Feeding frequency

When it comes to feeding preterm babies, several factors influence the frequency of feedings:

• the general condition of the baby;
• body weight immediately after birth;
• degree of immaturity.

If the baby has pathologies, you need to feed him often - up to 10 times a day. The norm is 7 or 8 meals a day with 3-hour breaks.

Babies who cannot swallow and suck are fed with special probes - they are inserted into the ventricle through the nose. As the baby grows, they are transferred to bottle feeding or breastfeeding.

Mother's milk

It is no secret that the best nutritional option for any baby up to a year old (including premature ones) is breast milk. The protein composition of colostrum, which is produced in the first 3-5 days after childbirth, as well as transitional and especially mature milk of a nursing mother, is optimal for a premature baby.

Such food is rich in lactose, which is quickly broken down, absorbed and absorbed by the child's body. Mother's milk has a number of important functions, including:

• provides reliable protection of the intestinal mucosa;
• prevents the attack of viruses and bacteria;
• minimizes the negative impact of allergens.

In women who have given birth to a child ahead of schedule, the composition of milk is somewhat different from the standard. The fat content is much lower than normal, but the percentage of proteins, on the contrary, is increased. But this is exactly what a premature baby needs.

Attachment to the chest

As soon as the sucking reflex is formed in the premature baby and the doctors state that he is feeling satisfactory, the baby begins to breastfeed.

To save the strength of a baby weighing more than 2 kg, attachment to the mother's breast is carried out only 1-2 times a day. The rest of the feeding is done with the help of a pacifier.

With the appearance of signs of fatigue, which are manifested by lethargy of sucking, as well as a blue area around the mouth, breastfeeding is temporarily suspended and a bottle of previously expressed milk is used. At this time, the doctor should monitor the amount of milk eaten by the baby by weighing the baby before and after feeding.

Quantitative norms

On the first day of a baby's life, the volume of each next feeding should exceed the volume of the previous one by 5 ml. Ideally, on the 3rd day, the amount of mother's milk drunk at a time reaches 15-20 ml. But these are only average data.

Permissible portions are set by the pediatrician on an individual basis. To calculate whether a child has received the norm of basic nutrients, doctors use the so-called "calorie" method of calculation.

According to the data, when a premature baby reaches the 1st month, the energy value of food per day should be 130-140 kcal per 1 kg of weight. Whereas for a timely born baby, only 115 kcal will be enough.

By the end of 2 months, children who weighed more than 1.5 kg at birth can reduce their caloric intake by 5 kcal per kg of body weight per day. Crumbs, who at birth weighed only 1-1.5 kg, are not recommended to reduce calories until they reach 3 months.

The amount of food needed specifically for your baby is prescribed by a pediatrician during a general examination.

Drink

Regarding drinking in the diet of infants, pediatricians completely rely on mother's milk, considering it both food and drink. Indeed, breast milk is quite enough to quench the thirst of an infant.

But you have to make allowance for prematurity. Prematurely born babies need regular thirst quenching not only through breast milk, but also through boiled, slightly sweetened, clean water.

vitamins

There is an opinion that breast milk contains a complete set of all substances necessary for growth and development. Even if the baby does not need to be given special vitamin preparations directly, then a nursing mother may need to think about it, especially if her baby was born prematurely.

But! Taking vitamins by a nursing woman is associated with high risks and requires medical supervision. Do not neglect the consultation with your doctor!

About iron deficiency

Premature babies often suffer from iron deficiency in the body. Moreover, this mineral is not present in sufficient quantities either in breast milk or in most types of special baby food.

Therefore, one has to rely on drugs in the form of syrups and drops, but with a limited course of administration. Here, too, you can not do without a medical consultation, otherwise you can harm the baby.

Formula feeding

Artificial feeding of premature babies involves the use of special infant formulas. But this can be done only after the approval of the doctor.

Large baby food companies have launched formulas for babies with low birth weight who rushed to be born ahead of schedule. The most famous brands for children up to a year:

• "Humana O";
• "Pre-Nan";
• "Pre Piltti";
• "Frisopre";
• Novalak-MM.

It is required to dilute the mixture with special bottled baby water, since simple boiled water is “heavy” for the baby’s stomach.

Even in the last century, premature babies were recommended to be fed with kefir, but today pediatricians do not recommend giving this product to prematurely born babies. Breast milk or formula is a much safer choice.

Complementary feeding tactics

Premature, weak, underweight babies need to introduce complementary foods as carefully as possible and at the same time take into account all the physiological parameters of the crumbs.

In case of prematurity (oatmeal, rice or buckwheat) with the addition of a small amount of breast milk or an adapted mixture.

It is very important to clearly follow the steps to increase the concentration of porridge, which is introduced into the children's diet:

• Initially, only 5% is given (100 ml of water per 1 tsp of crushed cereals).
• Further, the baby is allowed 7-8% (100 ml of water per 1.5 tsp).
• The final stage is 10% (100 ml of water per 2 tsp).

Closer to the year, you can add a drop of olive or sunflower oil to this children's dish, and only then - butter (3-4 g per serving). But oil should not be included at all in ready-made packaged instant cereals.

Juices

As a rule, pediatricians recommend that their patients start complementary foods with vegetable and fruit juices at the age of 3 months with one or two drops, gradually increasing the amount. However, today some experts question this technique and do not advise giving juices at all for up to six months.

If you support the ideas of early weaning, learn for yourself a few simple rules that will help you avoid problems.

1. Babies under 6 months should not be offered undiluted juices. This can be bad for a fragile stomach. Usually the juice is diluted with warm boiled water in a ratio of 1:1.
2. The main type of juice that is used for early feeding is apple juice.
3. For crumbs prone to constipation, it is recommended to try blackcurrant or beetroot juice.
4. With the introduction of carrot and grape drinks, one should not rush. Their child will try after a year, and tomato - after 3 years.
5. Allergic children should refrain from red juices (strawberry, raspberry, strawberry, etc.).

Puree

Fruit or vegetable puree is introduced only after the baby gets used to the juices. They usually start with 1/4 tsp.

From 3-4 months, a quarter of chopped boiled yolk can be added to vegetable puree. A few days after this, it is necessary to observe the reaction of the child's body to the new product.

It is undesirable to introduce two or more new products into the diet at the same time. Otherwise, if an allergic reaction occurs, you will not be able to determine its source.

Around the same age, a premature baby is introduced to cottage cheese: about 10 g during the first month, then up to 20 g, and so on, up to a single serving of 50 g.

From vegetables to meat

Meat puree for the prevention of anemia is included at the age of 5 months. Servings should not exceed 10 g, they do not need to be given more than 2-3 times during the week.

In a premature baby, be sure to eat mashed meats. At this time, a single portion increases and reaches 50 g by one year.

Already at 8 months it is quite logical to supplement the crumbs menu with unsweetened cookies or bread. At the same time, vegetable soups are introduced, which by the year are replaced with meat broths.

When planning the nutrition of premature babies, attention should be paid to the physical parameters of the child, not forgetting to monitor his weight gain on a monthly basis. The growth and development of premature babies are often more intensive. And therefore, at 2 years old, such babies often “catch up” and even “overtake” their peers.