Dietary Supplements

Evidence 

Enteral Nutrition in Preterm Infants (2022): A Position Paper From the ESPGHAN Committee on Nutrition and Invited Experts  

Most preterm infants receive PN, EN, and a transitional period in between influenced by local feeding practices, feeding intolerance, and metabolic intolerance. The transition phase is a critical time period for poor growth although early progressive PN and EN strategies may lead to reductions in the cumulative energy and protein deficits that occur during the first weeks of life. Standardized feeding guidelines and protocols, designed to maintain targeted intake throughout the transition phase can help to achieve nutritional goals 

Feeding Preterm Infants After Hospital Discharge: A Commentary by the ESPGHAN Committee on Nutrition  

Survival of small premature infants has markedly improved during the last few decades. These infants are discharged from hospital care with body weight below the usual birth weight of healthy term infants. Early nutrition support of preterm infants influences long-term health outcomes 

Education 

Babies born premature or sick may need extra vitamins and minerals for growth, so your baby may be given supplements to breast milk. Your baby’s doctor might recommend adding a breast milk fortifier—a special powder made from cow’s milk with extra vitamins and minerals—to help boost the nutrition in your breast milk. This can help with growth and bone development. 

Your baby’s doctor or dietitian will let you know if you need to keep using fortifiers after you go home, and for how long. The proper balance of calories, proteins, fats, electrolytes, vitamins, minerals, and fluids supports a premature or sick baby’s growth and development. It also helps the body’s systems function properly, boosts the immune system, promotes cell growth, and provides various other health and healing benefits. While breastmilk produces the most benefits, supplements are often required for premature or sick babies to meet their nutrition and growth needs. 

If you are unable to breastfeed, your baby will receive formula developed for their nutritional needs. Premature babies usually require formula that contains higher levels of energy, protein vitamins and minerals. These special preterm formulas help your baby to grow faster. Your team of health professionals will recommend the most appropriate one for your baby. 

What supplements will my baby need? 

The last trimester is an important time for transfer of vitamins to the baby. Babies born prior to the final trimester of pregnancy miss out on this transfer. As breast milk has low vitamin concentrations, the vitamins contained in breast milk fortifier are important. Fortified EBM (expressed breastmilk) largely meets vitamin requirements with the exception of vitamin D and vitamin A. It is important to follow the recommendations of your health care team when adding extra vitamins and minerals to your baby’s feeding plan as they will carefully consider the requirements against the amount provided from your baby’s breastmilk and/or formula. 

Vitamin D: Vitamin D plays an important role in your baby’s health, especially in helping their bones grow strong and supporting calcium absorption. Recommendations are that Vitamin D should be supplemented in preterm babies to during the first months of life. 

Vitamin A: Vitamin A helps support your baby’s growth and development, especially for healthy eyes and lungs. Babies born early often have low levels of vitamin A, which may increase their risk of developing ongoing lung problems. Vitamin A can be dangerous in high doses; so, ensure you follow the advice of your baby’s health professional team. 

Iron: Iron is vital for body function. It is especially important for brain development and making new red blood cells that transfer oxygen around the body. It also plays a role in immunity and growth. Babies born prematurely have lower iron stores than term babies and a higher risk of iron deficiency and anaemia.  

Once your baby is ready for solids, they will need iron rich foods.  

The best sources of iron are: 

• Red meat (such as beef, lamb, liver) 

• White meat (such as chicken, pork and fish) 

• Some plant-based foods are also high in iron, but they are not as easily absorbed as meat. Plant based foods containing iron include nuts and seeds, legumes and leafy green vegetables such as spinach.  

• Some cereals and breads are fortified with iron, for example rice cereal and Weet-Bix (or similar wheat-based cereals). Absorption can be boosted by pairing with foods rich in vitamin C such as fruits.  

If your baby is prescribed iron and vitamin D supplements at discharge, your doctor may continue these until solids are well established or until 12 months of age. 

Other Supplements 

• Pepti-Junior – is an infant formula which is prescribed for infants who have trouble digesting regular formula or for those with cow’s milk allergy. The nutrients are pre-digested which helps with absorption. Because Pepti-Junior is a medical formula, it needs to be prescribed by a doctor or dietitian. 

• Incremin –is an iron mixture which also contains lysine (an amino acid that is important for growth), vitamins B1, B6, and B12.   

• Pentavite – is an infant liquid multivitamin which contains a combination of vitamins (vitamin A, vitamin B1, vitamin B2, vitamin B3, vitamin B6, vitamin D3 and vitamin C) to assist with the healthy growth and development of infants and children from 0 up to 3 years. 

• Fergon - is an iron supplement used to treat iron deficiency anaemia in babies, adults and children. 

• Infloran – is a probiotic supplement to help support your baby’s digestive health and maintain the balance of healthy bacteria. It is commonly used during and after antibiotic use. These friendly bacteria support immune function. promotes and enhances healthy digestion. 

Always consult your health professional team before giving a premature or sick baby any extra supplements.  

Empowerment 

Some premature babies need extra nutrients to help them grow and develop. This may be because their gut is not developed enough to absorb some nutrients, or they may need extra nutrients because they are unwell.   

If your baby isn’t getting the right amount of nutrients from breastmilk or formula, the healthcare team may recommend giving them supplements. These come as powders or liquids that you mix with your baby’s usual milk.  

Most premature babies find it difficult to get enough vitamins from milk, even if they’re feeding well, so they will usually need vitamin supplements. This is very important to help their bones develop normally and to maintain optimal growth. You may need to carry on giving your baby supplements after you’ve taken them home. Reach out to your health professional team if you have any concerns regarding your baby’s growth and development.  

Useful Links 

Miracle Babies Foundation 

https://www.miraclebabies.org.au/content/other-forms-of-feeding/gjseqw 

https://www.miraclebabies.org.au/content/infloran/gkwdsg 

https://www.miraclebabies.org.au/content/low-iron/gk3rp4 

Department of Health – Victoria 

https://www.health.vic.gov.au/patient-care/supplements-for-the-preterm-infant 

Department of Health -NSW 

https://www.slhd.nsw.gov.au/RPA/neonatal%5Ccontent/pdf/guidelines/Enteral_Nutrition_Preterm_RPAH_GL2014_042.pdf 

Department of Health - WA 

https://cahs.health.wa.gov.au/~/media/HSPs/CAHS/Documents/Health-Professionals/Neonatology-guidelines/Vitamin-and-Mineral-Supplementation.pdf?thn=0 

Pregnancy Birth and Baby 

https://www.pregnancybirthbaby.org.au/children-and-vitamins 

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