Blog/News Archives

Understanding Postpartum Depression: A guide for Parents of Premature Babies

2024-04-02

In the first two weeks following childbirth, many mothers experience what is known as postpartum “baby blues”. This is characterized by mood swings encompassing feelings of anxiety, sadness, and irritability, along with disruptions to sleep patterns (either insomnia or excessive sleeping). These symptoms are triggered by the sudden decline in estrogen and progesterone hormone levels that occur after the baby is born¹.

However, one in seven new mothers the postpartum “baby blues” evolves into something more enduring known as postpartum depression (PPD)¹. Postpartum depression encompasses a spectrum of symptoms including depression, anxiety, feelings of shame or guilt, withdrawal from loved ones, and difficulty of finding pleasure in once-beloved activities. The bonding process between a mother and newborn can also be strained under the effects of PPD².

New parents are often overwhelmed when adjusting to life with a newborn, however, the stress of having a premature baby and the challenges of the neonatal intensive care unit (NICU) environment can compound these feelings of anxiety and depression in parents. Parents of premature babies may face unique stressors such as uncertainty about their baby’s health, prolonged hospital stays, lack of bonding with the baby, and the potential various medical interventions that preemies often need³.

It is crucial for parents of premature babies to recognize when postpartum depression may be at play. If you have been experiencing any of the following symptoms for more than 2 weeks, please reach out to your healthcare provider:

Research indicates that mothers of premature babies or infants with prolonged hospitalization face an increased risk of experiencing postpartum depression⁴. In addition to this, various risk factors for postpartum depression include:

Studies have underscored the significance of hospital culture in addressing the psychological needs of mothers of a preterm infant. The admission of premature babies into the NICU has a significant impact on the entire family. Involvement from day one of neonatal nurses and clinicians is crucial for optimizing the care for mothers immediately after preterm birth and during the infant’s hospitalization, in order to help mitigate postpartum depression. In the NICU environment, new parents often find themselves unable to engage in anticipated parenting activities such as holding, bathing, feeding, and comforting their infant⁶. This can lead to feelings of loss of a parental role, helplessness, and inability to protect their baby as clinical team members assume primary caregiving responsibilities instead⁷. Hospitals can address these emotions by adopting a family-integrated model, allowing parents to actively engage in all aspects of their infant’s care during their NICU stay⁶. Utilizing tools such as webcams or virtual platforms to provide visual updates on their child has been shown to promote attachment and bonding. Significant milestones, such as “moving to an open crib” or “bottle feeding”, can be shared with caregivers through GDPR/HIPAA-compliant platforms. Involving parents in their preemie’s NICU journey can support maternal- and paternal-infant bonding and reduce the risk of postpartum depression⁶.

There are a few additional protective factors against postpartum depression, including:

Breastfeeding, due to its facilitation of maternal-infant bonding
Social support, covering emotional, financial, and practical assistance
Regular engagement in physical activity⁸

In summary, postpartum depression can significantly impact parents of premature babies, adding to the challenges already inherent in adjusting to life with a newborn. By recognizing the signs of PPD and implementing strategies to support parental well-being both at the NICU and in the home setting, healthcare providers can help alleviate the burden of postpartum depression for parents of premature babies and facilitate a smoother transition into parenthood.

REFERENCES

¹ Mughal, S., Azhar, Y., & Siddiqui, W. (2022). Postpartum Depression. In StatPearls. StatPearls Publishing.

² Faisal-Cury, A., Bertazzi Levy, R., Kontos, A., Tabb, K., & Matijasevich, A. (2020). Postpartum bonding at the beginning of the second year of child’s life: the role of postpartum depression and early bonding impairment. Journal of psychosomatic obstetrics and gynaecology, 41(3), 224–230. https://doi.org/10.1080/0167482X.2019.1653846

³ Hendy, A., El-Sayed, S., Bakry, S., Mohammed, S. M., Mohamed, H., Abdelkawy, A., Hassani, R., Abouelela, M. A., & Sayed, S. (2024). The Stress Levels of Premature Infants’ Parents and Related Factors in NICU. SAGE open nursing, 10, 23779608241231172. https://doi.org/10.1177/23779608241231172

⁴ Tahirkheli, N. N., Cherry, A. S., Tackett, A. P., McCaffree, M. A., & Gillaspy, S. R. (2014). Postpartum depression on the neonatal intensive care unit: current perspectives. International journal of women’s health, 6, 975–987. https://doi.org/10.2147/IJWH.S54666

⁵ Ghaedrahmati, M., Kazemi, A., Kheirabadi, G., Ebrahimi, A., & Bahrami, M. (2017). Postpartum depression risk factors: A narrative review. Journal of education and health promotion, 6, 60. https://doi.org/10.4103/jehp.jehp_9_16

⁶Nyberg, N. (2023). Importance of connectedness to attachment for NICU parents. Neonatal Intensive Care, 36(1).

⁷ Woodward, L. J., Bora, S., Clark, C. A., Montgomery-Hönger, A., Pritchard, V. E., Spencer, C., & Austin, N. C. (2014). Very preterm birth: maternal experiences of the neonatal intensive care environment. Journal of perinatology : official journal of the California Perinatal Association, 34(7), 555–561. https://doi.org/10.1038/jp.2014.43

⁸ Vigod, S. N., Villegas, L., Dennis, C. L., & Ross, L. E. (2010). Prevalence and risk factors for postpartum depression among women with preterm and low-birth-weight infants: a systematic review. BJOG : an international journal of obstetrics and gynaecology, 117(5), 540–550. https://doi.org/10.1111/j.1471-0528.2009.02493.x

Anxiety and Premature Birth: Navigating Emotions for a Healthy Pregnancy

2024-03-17

In modern-day society, anxiety has become increasingly prevalent worldwide, likely attributable to the overwhelming pace of modern life. It presents as persistent worrying and apprehension often without a clear cause, accompanied by physical symptoms such as difficulty breathing, trouble sleeping, sweating, trembling, stomach pain, or nausea. These symptoms can significantly interfere with daily activities and diminish one’s overall well-being. Given the myriad stressors in today’s world, it is increasingly common for expectant mothers to grapple with anxiety during pregnancy.

During pregnancy it is natural for expectant mothers to experience a range of emotions, from anticipation to anxiety. However, recent research conducted at UT Southwestern has found a strong link between anxiety levels and preterm birth1. This study showed that women who had given birth to preterm babies had significantly higher general anxiety disorder scores than other women. Furthermore, women who received a positive anxiety screening and underwent mental health therapy, while pregnant, often averted preterm birth. This underscores the importance of early intervention for treating anxiety symptoms.

Fortunately there is a range of effective strategies for managing anxiety during pregnancy:

Cognitive Behavioral Therapy (CBT) focuses on reframing negative thought patterns and incorporating anxiety management strategies2. While the most effective implementation of CBT involves working with a trained therapist, there are accessible resources available for self-guided CBT, such as workbooks and online courses.
Mindfulness techniques such as grounding exercises, in which one sits down and takes a few deep breaths while focusing on their surroundings. The intention is to notice things you can see, touch, hear, smell, and taste in order to bring one’s attention to the present moment and distract oneself from anxious thoughts. Studies have shown that pregnant women who participated in the mindfulness program, “mindful motherhood”, reported reduction in anxious feelings, stress, and hostility3.
Journaling can be beneficial in navigating anxious feelings by providing a means to help work through them. By documenting and writing down one’s worries, individuals can revisit them, offering an opportunity to reframe their perspective and gain insight into their emotions.
Incorporating relaxation techniques, such as yoga, massage, meditation, tai chi, and aromatherapy into daily routines can help to promote a sense of calmness and well-being during pregnancy
Physical activities such as walking or aquatic aerobic exercises offer not only physical benefits but act as effective stress management tools. Engaging in regular exercise can help to manage stress and anxiety levels.

In cases of severe anxiety symptoms, medication may be considered. Selective serotonin reuptake inhibitors (SSRIs) are commonly prescribed for depression and anxiety both during pregnancy and postpartum. SSRIs include fluoxetine (Prozac), citalopram (Celexa), Escitalopram (Lexapro) and Sertraline (Zoloft). However, there have been temporary infant symptoms linked with SSRIS use, include tremors, crying, feeding difficulties, and jitteriness4. These symptoms typically resolve within the first 28 days after birth. It is crucial to discuss with your healthcare provider whether the SSRI use during pregnancy is appropriate for you. However, studies have shown that Benzodiazepines such as Xanax during pregnancy should not be used due to potential association with increased risk for cleft lip birth defect (a split opening in the upper lip that is caused by the tissues forming the upper lip not coming together during fetal development)5.

By implementing stress-reducing strategies, expectant mothers can aim for a healthier pregnancy journey and decrease the likelihood of premature birth.

REFERENCES

Rodriguez, A. N., Ambia, A. M., Fomina, Y. Y., Holcomb, D., Wolfson, T., Doty, M., Corona, R., Dominguez, J., Peters, M., McIntire, D., & Nelson, D. B. (2023). A prospective study of antepartum anxiety screening in patients with and without a history of spontaneous preterm birth. AJOG global reports, 3(4), 100284. https://doi.org/10.1016/j.xagr.2023.100284
Uguz, F., & Ak, M. (2021). Cognitive-behavioral therapy in pregnant women with generalized anxiety disorder: a retrospective cohort study on therapeutic efficacy, gestational age and birth weight. Revista brasileira de psiquiatria (Sao Paulo, Brazil : 1999), 43(1), 61–64. https://doi.org/10.1590/1516-4446-2019-0792
Dunn, C., Hanieh, E., Roberts, R., & Powrie, R. (2012). Mindful pregnancy and childbirth: effects of a mindfulness-based intervention on women’s psychological distress and well-being in the perinatal period. Archives of women’s mental health, 15(2), 139–143. https://doi.org/10.1007/s00737-012-0264-4
Stephanie Collier, M. (2021, June 25). How can you manage anxiety during pregnancy?. Harvard Health. https://www.health.harvard.edu/blog/how-can-you-manage-anxiety-during-pregnancy-202106252512
Dolovich, L. R., Addis, A., Vaillancourt, J. M., Power, J. D., Koren, G., & Einarson, T. R. (1998). Benzodiazepine use in pregnancy and major malformations or oral cleft: meta-analysis of cohort and case-control studies. BMJ (Clinical research ed.), 317(7162), 839–843. https://doi.org/10.1136/bmj.317.7162.839

Microplastics and Pregnancy: A Growing Concern

2024-01-30

Plastic pollution is a known global environmental crisis. But nowadays, people are focusing their concerns on microplastics, particles less than five millimetres in size, infiltrating every corner of our planet. These tiny fragments can be found in our oceans, soil, air, and even our food and water. While the impact of microplastics on human health is still being investigated, recent studies have raised concerns about their potential effects on pregnant women and their unborn babies.

How Do Microplastics Enter the Body?

Humans can be exposed to microplastics through various routes, including ingestion, inhalation, and dermal contact. Ingestion is the most common pathway, with microplastics often found in food, water, and dust. Inhalation occurs through breathing in microplastic-contaminated air, primarily indoors. Dermal contact is also possible, particularly in areas with abundant microplastics, such as near beaches or construction sites.

Pregnant women are particularly vulnerable to microplastic exposure due to their physiological changes and increased contact with environmental sources. One of the most alarming findings is the presence of microplastics in the placenta, the organ that connects the mother to the fetus and provides essential nutrients and oxygen. Studies have detected microplastics in the placentas of women worldwide, raising concerns about the potential risks to the developing baby.

Potential Health Effects

The potential health effects of microplastics on pregnant women and their unborn babies are still being elucidated. However, several concerns have been raised, including:

Exposure to microplastics during pregnancy could increase the risk of adverse birth outcomes, such as premature birth, low birth weight, and birth defects.
Microplastics could carry harmful chemicals that can disrupt the development of the fetus’s immune, nervous, and reproductive systems.
Microplastics could contribute to inflammation and oxidative stress, which can have negative consequences for fetal development.

The same applies to the effects of microplastics on premature babies. While researchers are still trying to gather information to reach a valid conclusion, several potential concerns have emerged:

Immune System Disruption: Microplastics can carry harmful chemicals that can suppress the immune system, making premature babies more susceptible to infections.
Respiratory Issues: Inhalation of microplastics may trigger respiratory problems, such as asthma and allergies.
Neurological Development: Microplastics can disrupt brain development, leading to cognitive impairments and behavioural problems.
Growth and Development: Exposure to microplastics may hinder growth and development, particularly in premature babies who are already developmentally at risk.
Preterm Birth: Some studies suggest a link between microplastic exposure and increased risk of preterm birth.

Minimise Exposure to Microplastics

While more research is needed to fully understand the impact of microplastics on premature babies, some steps can be taken to minimise exposure:

Breastfeeding: Breastfeeding is the preferred method of feeding for premature babies, as it provides essential nutrients while minimizing the risk of microplastic contamination.
Hygiene Practices: Strict hand washing by caregivers and minimizing exposure to dust and contaminated surfaces can help reduce microplastic exposure.
Environmental Measures: Reducing plastic waste in the home and community can help overall exposure levels.
Education and Awareness: Raising awareness among healthcare providers and parents about microplastic pollution is crucial for informed decision-making.
Limit consumption of processed foods and bottled water, as these are more likely to contain microplastics.
Stay informed about microplastic pollution and advocate for policies that reduce plastic waste.

The presence of microplastics in the placenta is a significant concern that warrants further investigation. Pregnant women should be aware of the potential risks and take steps to minimize their exposure. By working together to reduce plastic pollution, we can protect the health of mothers and their babies for generations to come.

In conclusion, the infiltration of microplastics into various aspects of our environment has emerged as a critical concern, particularly for pregnant women and their unborn babies. The pathways through which microplastics enter the human body, coupled with the vulnerability of pregnant women to exposure, have raised alarms about potential health effects.

While the precise impact of microplastics on pregnancy is still under investigation, studies have identified the presence of these tiny particles in the placenta, emphasizing the urgent need for further research. Concerns include the potential for adverse birth outcomes, disruptions to fetal development, and the possibility of long-term health consequences for both mothers and their babies.

Addressing this issue requires a multi-faceted approach, encompassing personal lifestyle choices, healthcare practices, and broader environmental measures. From adopting breastfeeding as a preferred method for premature babies to advocating for reduced plastic waste and raising awareness among healthcare providers and the general public, collective efforts are crucial in minimizing the risks associated with microplastic exposure.

As we navigate the intricate landscape of microplastic pollution, staying informed and actively participating in efforts to reduce plastic waste becomes paramount. By taking these steps, we can contribute to safeguarding the health of current and future generations, ensuring a healthier, plastic-free environment for mothers and their babies alike.

REFERENCES

Microplastics in placentas: occurrence, sources, and effects: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9517680/

Rise of microplastics discovered in placentas of Hawaiʻi mothers: https://www.hawaii.edu/news/2023/11/29/rise-of-microplastics-in-placentas/

Microplastics exposure: implications for human fertility, pregnancy and child health: https://www.frontiersin.org/articles/10.3389/fendo.2023.1330396

Plasticenta: First evidence of microplastics in human placenta: https://pubmed.ncbi.nlm.nih.gov/36141864/

Microplastics revealed in the placentas of unborn babies: https://www.theguardian.com/environment/2020/dec/22/microplastics-revealed-in-placentas-unborn-babies

The Microbiome’s Role in the Health of a Newborn

2023-11-20

In this blog post we are aiming to explore what the newborn microbiome is and why it is crucial to the long-term health of your infant.

The microbiome is a community of microorganisms, such as bacteria, fungi, and viruses numbering 10-100 trillion which live within and on the human body. The microbiome encompasses not only the microbiota but also the genes they carry. Understanding your newborn’s microbiome and its importance is a first step in guaranteeing a healthy child, because the first microbiota have an extremely important role in the long-term health of your infant.

Your newborn’s microbiome plays a large role even prior to birth. During pregnancy, the maternal microbiota has a profound effect on the development of the fetus. Studies have shown that expecting mothers who suffer pregnancy complications have a reduced bacterial diversity of their gut microbiota, and this lack of diversity is often detrimental to the health of both the mother and the fetus.

But did you know that the microbiota of the pregnant mother is also affected by the diet she eats? So, what you consume during pregnancy matters tremendously. Consuming sugary drinks and processed foods leads to inflammation and disrupts your gut bacteria’s balance. The microbiota is negatively affected by several key factors including a poor diet, the use of antibiotics, recurrent infections, and even stress.

Whеn babiеs arе born, thе bacteria in thеіr intestines are influenced by both thеir еnvironmеnt and thеir bodiеs. This means that some of these bactеria are good for the baby, while others can be harmful. Its also important to state if some beneficial bacteria are out of balance, they can negatively affect the infant’s health. It is rеally important what type of bactеria a baby is еxposеd to at birth, especially thе exposure the infant receives from the mothеr. Research shows that bactеria from thе mothеr’s vagina and skin can be found in thе baby’s poop, and that babiеs born through thе birth canal havе lots of hеlpful bactеria such as Lactobacillus and Bifidobacterium, which comеs from thе mothеr’s vaginal bactеria.

Lactobacillus have been shown to reduce lactose intolerance, regulate immunity, improve gastrointestinal diseases, and reduce cancer risk. They have a beneficial effect in preventing necrotizing enterocolitis (NEC) in preterm infants.

On the other hand, Bifidobacterium species are among the first microbes to colonize the human gastrointestinal tract and exert health benefits. These bacteria play a crucial role in infant development by serving as a source of nutrition for colonocytes, which are cells that reside within the colon. They help digest dietary fiber and prevent infection, and they produce vitamins. Low bifidobacteria counts have been linked to many diseases, while supplementation may help treat symptoms of certain diseases.

It is always amazing to see that breastfed infants have higher levels of bifidobacteria in their intestines because breast milk provides infants with maternal microbes, essential nutrients, and antibacterial agents crucial for their well-being. In particular, human milk oligosaccharides (HMOs), which are uniquely found in human milk, play a role as prebiotics by promoting the growth of beneficial bacteria such as Bifidobacterium.

Several studies are showing that breastfed infants primarily have Bifidobacterium-dominated gut microbiota, while formula-fed infants have a mix of Bacteroides and Bifidobacterium. Bacteroides are bacteria involved in microbial balance and neuroimmune health, but high levels of these bacteria may cause reduced digestive capacity and even constipation. Therefore, the method of feeding your baby is closely linked to their gastrointestinal microbiota and breastfeeding is recognized for its role in shaping the optimal infant’s gut microbiota, particularly by increasing the presence of Bifidobacterium.

As an example, babies when delivered via cesarean have the microbial diversity in their guts disrupted and reduced. So, many of these preterm infants miss out on having Bifidobacterium in their microbiome. But interestingly enough, a recent study shows that when exposing cesarean-born infants to vaginal fluid within 30 days of birth, can significantly improve their oral, gut, and skin microbiota. It’s also interesting to note that babies born via a cesarean section have a higher chance of developing autoimmune diseases, asthma, obesity, and allergies.

So, the birth method significantly affects the infant’s gut microbiota. Babies born vaginally tend to inherit microbes that are health protective and are similar to their mother’s vaginal flora, while those delivered via cesarean section inherit microbes resembling their mother’s skin bacteria. These differences in infant microbiota due to delivery methods may be due to the “bacterial baptism” from vaginal fluid, though some argue that antibiotics during delivery, maternal inactivity, and pregnancy complications may also play an important role.

Further, premature infants differ from full-term babies as they struggle to colonise beneficial bacteria such as Bacteroides and Bifidobacterium, and some of them exhibit increased Enterococcus and Enterobacteriaceae in their feces (these two types of bacteria can spread to the bloodstream and cause life-threatening complications). The interaction between the preterm infants’ immature microbiota and weak immune systems can lead to inflammation and serious infectious diseases.

Although some of the bacteria described here are in general beneficial, the preterm infant microbiota should be seeded naturally and not with the use of products containing live bacteria or yeast (commonly called probiotics). Please note that recently (September 2023) the U.S. Food and Drug Administration (FDA) has provided important safety information to healthcare providers on the use of probiotics in preterm infants. The FDA cautions that microorganisms contained in probiotics have been reported in the medical literature as causing bacteremia or fungemia, sometimes with a severe clinical course, in very preterm or very low birthweight (VLBW) infants.

Environmental factors also impact early-life microbiota colonization. For instance, family members have been recognized as potential influencers on the infant’s gut microbiota. Notably, a Dutch study revealed that infants with siblings tend to have a higher presence of Bifidobacterium in their gut microbiota, as well as an increase in the abundance and diversity of gut microbes when compared to those without siblings. Moreover, infants without older siblings usually show higher levels of Clostridium and Escherichia coli (E. coli).

A baby’s microbiome starts with just a few types of bacteria, and as the infant grows the types of bacteria become more diverse. Some specific bacterial types are present in the first fеw days aftеr birth, and then Bifidobactеrium bеcomеs dominant. Whеn babiеs start еating solid food, their gut bacteria become similar to those of adults. It takes a couplе of yеars for a baby’s gut bactеria to fully maturе into adult-likе gut bactеria.

In summary, the microbiota in early life is not only a key regulator of infant health but also associated with long-term health. During pregnancy, the maternal microbiota affects the development of the fetus, a disorder of the maternal microbiota can lead to adverse pregnancy outcomes. After birth, the infant microbiota are affected by both the birth-method and the feeding given to the infant. The microbiomes of C-section infants are different from those of babies born vaginally; they have lower numbers of “good” bacteria such as Lactobacillus and Bifidobacterium. However, Breastfeeding regulates the gut microbiota of the newborn and is associated with the abundance of these good bacteria in the intestines of the infant. These bacteria strengthen the infant’s immune system and are beneficial to the infant’s overall health. Even if your infant is born by a Cesarean section you can still help modulate the infant’s microbiota by breastfeeding.

ESPGHAN Guidelines: Neonatal Nutrition

2023-09-30

The European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) is a group dedicated to promoting the health of children with a focus on the gastrointestinal tract, liver, and nutritional needs. ESPGHAN disseminates science-based information and advice on the best practices to meet the nutritional needs of children. ESPGHAN has four special interest groups dedicated to specific aspects of pediatric health: gut microbiota and modification, clinical malnutrition, neonatal nutrition, and childhood obesity. The neonatal nutrition committee of ESPGHAN provides neonatal professionals with quick and easy access to recommendations on nutrient intakes and nutritional practice in preterm infants with birth weight less than 1800 g.

Preterm infants have increased nutritional requirements compared to full-term infants, and recommendations have been made by ESPGHAN regarding the optimal ranges for their nutrient intakes. However, breast milk alone does not meet these recommendations. Therefore, breast milk often requires the addition of a breast milk fortifier, which is a commercial product designed to enhance the energy, protein, fat, mineral, and micronutrient content of breast milk.

In this blog we focus on the latest ESPGHAN recommendation for protein, fat, fatty acids, and energy intake, and on the use of mother’s or donor milk in preterm infant feeding. We will compare their recommendations from 2010 with the revised recommendations from 2022.

Protein Intake Recommendations

Protein quality and quantity are crucial, due to their important role in the growth and development of infants. As explained above breast milk alone does not provide the higher protein requirements to match intrauterine growth rates. Studies have shown improved preterm infant growth rates with increased protein intake. ESPGHAN recommendations for protein to match intrauterine growth rates are as follows:

The recommendation of 2022 also states that protein intake can be increased to 4.5 g/kg per day if growth is slow but provided protein quality is good, and there are no other causes for the slow growth. ESPGHAN 2022 also recommends regular monitoring of plasma urea concentrations to help estimate the actual protein that the infant intakes and absorption. Their recommendation is that for low urea concentrations the doctor needs to increase protein intake up to 4.5 grams per kilogram per day, but for high concentrations the infant is likely getting enough protein. However, if the urea concentrations exceed 34 mg/dL without the infant having any renal issues, and there is sufficient energy intake, then ESPGHAN 2022 recommends reducing the protein intake.

Fat and Fatty Acid Intake Recommendations

Preterm babies need a lot of energy, and about half of this energy comes from the fats they get from the breast milk that they ingest. Fat also provides complex things like fatty acids, vitamins, and other complex fats. Breast milk contains about 3.2 to 4.0 grams of fat per 100 milliliters. This fat is composed of tiny globules made up of 98-99% triglycerides and a membrane enclosing them that has other important things like phospholipids, cholesterol, and other highly bioactive components. Fatty acids are the building blocks of the fat in our bodies. Certain fatty acids such as arachidonic acid (ARA) and docosahexaenoic acid (DHA) are actively transferred through the placenta during the third trimester of pregnancy and they are essential for neurological development. Some preterm infants may not have been exposed to this placental transfer since they were born too soon, and so might not have enough ARA or/and DHA. Furthermore, their bodies can’t make them out of other fats as they should. Not having enough of these fats can lead to problems such as increased risk of retinopathy of prematurity (a common eye disease in preterm infants), septicemia (also called sepsis, blood poisoning by bacteria), and severe bronchopulmonary dysplasia (a form of chronic lung disease that affects infants).

One way to make sure that preterm babies get enough ARA or/and DHA in their daily diet is to add these polyunsaturated fatty acids to their food; keep in mind that we should not exceed the daily recommended dose. Below are the ESPGHAN 2022 revised recommendations for fat, ARA, and DHA. As you can see the 2022 recommendations support a much larger dosage of both ARA and DHA. These recommendations are supported by a study by Hellstorm and colleagues (2021) undertaken at Lund University in Sweden.

Energy Intake Recommendations

Energy is crucial for preterm infants. Premature neonates can have an energy-deficient state due to illness, neurodevelopmental energy requirements, drops in blood oxygen levels, and the possibility of stressful stimuli. Failure to correct energy deficiency in premature infants may lead to adverse effects such as neurodevelopmental delay and negative long-term metabolic and cardiovascular outcomes. The old and new recommendations by ESPGHAN are as follows:

ESPGHAN 2022 recommends that the total energy intake for a healthy preterm infant should be between 115 to 140 kcal/kg per day, and that energy intakes exceeding 140 kcal/kg per day are recommended only if growth falls below the recommended range.

Regarding breast milk, ESPGHAN states that the first choice for feeding infants is to use mother’s own milk (MOM) over donor human milk (DHM). However, if MOM is insufficient, then the infant should receive fortified DHM over preterm formula, especially for those infants born at less than 32 weeks’ gestation or birth weight less than 1500 g. Furthermore, pasteurization of MOM is not recommended as it reduces the activity of bioactive factors.

In conclusion, nutritional needs of preterm infants are unique and ever changing. The variability in the nutrient content of mother’s or donor milk emphasizes the importance of a tailored approach in order to meet ESPGHAN recommendations for all macronutrients. Fortunately, the Preemie ecosystem tackles this challenge head-on by facilitating rapid and cost-effective analysis of human milk composition, and providing data-driven calculations for personalized fortification. The use of the Preemie ecosystem ensures that every preterm infant receives optimal nutritional support by ensuring human milk meets the new ESPGHAN recommendations.

REFERENCES

Embleton, N. D., Jennifer Moltu, S., Lapillonne, A., van den Akker, C. H. P., Carnielli, V., Fusch, C., Gerasimidis, K., van Goudoever, J. B., Haiden, N., Iacobelli, S., Johnson, M. J., Meyer, S., Mihatsch, W., de Pipaon, M. S., Rigo, J., Zachariassen, G., Bronsky, J., Indrio, F., Köglmeier, J., de Koning, B., … Domellöf, M. (2023). Enteral Nutrition in Preterm Infants (2022): A Position Paper From the ESPGHAN Committee on Nutrition and Invited Experts. Journal of pediatric gastroenterology and nutrition, 76(2), 248–268. https://doi.org/10.1097/MPG.0000000000003642

Hellström, A., Pivodic, A., Gränse, L., Lundgren, P., Sjöbom, U., Nilsson, A. K., Söderling, H., Hård, A. L., Smith, L. E. H., & Löfqvist, C. A. (2021). Association of Docosahexaenoic Acid and Arachidonic Acid Serum Levels With Retinopathy of Prematurity in Preterm Infants. JAMA network open, 4(10), e2128771. https://doi.org/10.1001/jamanetworkopen.2021.28771

Nurturing Vital Beginnings: The Role of Supplements During Pregnancy

2023-08-10

During pregnancy, making sure you and your baby have the proper nutrition is crucial. Micronutrient deficiencies during this time have been associated with all sorts of pregnancy complications, such as premature birth, and can have adverse effects on fetal growth and development. To address this many expecting mothers turn to vitamin supplementation during pregnancy.

But, here’s the thing:

Brands that offer multivitamins for pregnancy often oversimplify the process of supplementation. Some brands contain excessive amounts of vitamins and minerals that could potentially be risky.
Brands often instruct you to take them daily during all trimesters; however, your baby’s nutritional needs often depend on which trimester of the pregnancy you are in. For example, excessive use of Vitamin C and Vitamin E at 12-18 weeks gestation increases risk of fetal loss¹.
Multivitamin brands lack scientific evidence to support their claims of being better than competitors.

To simplify the process, here is a guide for some essential supplements you need during pregnancy:

1. Folic Acid: You need this before conception and during the first trimester to reduce risk of neural tube defects, which affect the brain, and to improve spinal cord development in the baby. After the neural tube has closed, you don’t usually need to keep taking it¹. As we previously mentioned in our blog, folic acid can help prevent birth defects of the brain and spine, and may help prevent premature birth. However, folate has to be broken down by the body to make it active and absorbable so that the cells can make use of it, but many women have the MTHFR gene mutation which inhibits this process and therefore their body cannot break down folic acid. There are lab tests you can do to check if you have this mutation. If you do, your doctor may recommend methylated folate (methylfolate), which is the active form of folate that your body can use.
2. Vitamin B12: Adequate vitamin B12 supply is essential for proper fetal growth. If you are vegetarian, it becomes particularly important due to your limited intake of animal-based foods, which are the primary source of this vitamin². Also, B12 is the most important nutrient for you to absorb your folate. If you don’t have enough B12, you can’t metabolize your folate or your methylfolate, so it is important to take these two supplements together.
3. Vitamin B6: Deficiency in vitamin B6 is associated with various pregnancy complications such as pre-eclampsia, gestational carbohydrate intolerance, hyperemesis gravidarum (severe morning sickness), and neurologic diseases in infants.
4. Calcium: During the second trimester you will need to increase your calcium intake, as your baby’s skull and skeleton undergo rapid growth. Adequate calcium intake helps support the baby’s developing bones and teeth¹.
5. Choline: Plays a critical role in neural tube closure and brain development. Adequate levels of this nutrient can help prevent spina bifida and anencephaly. This supplementation should be taken prior to conception and during the second trimester.³
6. Iron: This is especially important during your second and third trimesters to prepare for post-delivery blood loss and to prevent maternal anemia, which can have adverse effects on both your health and the baby’s development¹.
7. Vitamin D: This is key for your baby’s growth, bone metabolism, and immune system development. Pregnant women with vitamin D deficiency, especially in the third trimester, benefit from vitamin supplementation. We suggest you have your vitamin D levels checked regularly during pregnancy. Vitamin D is responsible for increasing intestinal absorption of calcium, magnesium, and phosphate, and also provides improved resistance to certain diseases. Vitamin D also regulates mood and reduces depression¹. Vitamin D is also called the sunshine vitamin because your body produces vitamin D naturally when it’s directly exposed to sunlight. It is recommended to get 10-30 minutes of sunlight several times per week⁴. If you take vitamin D3 regularly over a long period, you definitely need to also take vitamin K2; these two vitamins work together to strengthen bones and promote the health of the heart and arteries.
8. Omega-3 fatty acids: Especially docosahexaenoic acid (DHA) which is essential for the growth and functional development of the brain in infants and is also required for maintenance of normal brain function in adults. During the second half of the pregnancy the most rapid neural and retinal development occurs and therefore, supplementation with omega-3 fatty acids, especially DHA, is especially important. Note that this is usually an animal product, but vegan supplements are available. Also, things like omega-3 eggs or milk contain little or no DHA, but rather different types which are not effective.

Now, let’s talk about the risks of taking high doses of certain vitamins:

Vitamin C & E: During weeks 12-18 of gestation excessive intake of these vitamins could increase risk of fetal loss or perinatal death¹.
Vitamin A: This vitamin is a known teratogen, which means that excessive intake during pregnancy can increase the risk of congenital malformations in your baby¹.
Vitamin E: There is evidence suggesting that too much of this vitamin during pregnancy may increase the risk of gestational hypertension and low birth weight (LBW)¹.

If you are thinking about adding a pregnancy multivitamin to your routine a good place to start on recommended doses is the American College of Gynecologists and Obstetricians (ACOG) guidelines. They and other health institutes recommend the following dosages:

Additionally, you may want to consider taking probiotics, also known as “beneficial bacteria”. Probiotics are not vitamins, they can be found in foods like yogurt, kimchi, kefir, sauerkraut, and tempeh, and are also available as food supplements. The most widely used probiotics are live bacteria such as Lactobacillus and Bifidobacterium species and nonpathogenic yeast such as Saccharomyces. Most probiotics have been shown to be safe to consume during pregnancy. However, there are no published studies addressing the safety of Saccharomyces species use in pregnancy⁷.

To wrap it up, monitoring your vitamin intake during pregnancy is super important for both you and your baby. Make sure to always talk to your healthcare provider before starting any new supplements. Additionally, many of the vitamins we mentioned can be found in a healthy, well-rounded diet. With the right nutrition and vitamins on your side you are all set for a healthy pregnancy journey!

REFERENCES

Petrikovsky B.M. (2021) A New System of Vitamin Administration During Pregnancy and Postpartum. The journal of perinatology neonatology, 34(4), 22-23.
Hovdenak, N., & Haram, K. (2012). Influence of mineral and vitamin supplements on pregnancy outcome. European journal of obstetrics, gynecology, and reproductive biology, 164(2), 127–132. https://sci-hub.se/https://doi.org/10.1016/j.ejogrb.2012.06.020
Obeid, R., Derbyshire, E., & Schön, C. (2022). Association between Maternal Choline, Fetal Brain Development, and Child Neurocognition: Systematic Review and Meta-Analysis of Human Studies. Advances in nutrition (Bethesda, Md.), 13(6), 2445–2457. https://doi.org/10.1093/advances/nmac082
Jindal, A. K., Gupta, A., Vinay, K., & Bishnoi, A. (2020). Sun Exposure in Children: Balancing the Benefits and Harms. Indian dermatology online journal, 11(1), 94–98. https://doi.org/10.4103/idoj.IDOJ_206_19
Institute of Medicine (US) Standing Committee on the Scientific Evaluation of Dietary Reference Intakes and its Panel on Folate, Other B Vitamins, and Choline. (1998). Dietary Reference Intakes for Thiamin, Riboflavin, Niacin, Vitamin B6, Folate, Vitamin B12, Pantothenic Acid, Biotin, and Choline. National Academies Press (US). https://www.ncbi.nlm.nih.gov/books/NBK114310/
National Institutes of Health, Office of Dietary Supplements. (n.d.). Vitamin B6 – Health Professional Fact Sheet. Retrieved from https://ods.od.nih.gov/factsheets/VitaminB6-Consumer/
Elias, J., Bozzo, P., & Einarson, A. (2011). Are probiotics safe for use during pregnancy and lactation? Canadian family physician Medecin de famille canadien, 57(3), 299–301. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3056676/

An interview with Nicole Nyberg, Neonatal Nurse Practitioner, and founder of Empowering NICU Parents Podcast

2023-07-21

In the world of neonatal care, Nicole Nyberg is a dedicated Neonatal Nurse Practitioner(NNP) and a proud mother of a preemie, who has embarked on a mission to empower neonatal parents. In her podcasts, Nicole shares her work and knowledge as a neonatal nurse and as a preemie mother. Recently, the Preemie team had the pleasure to interview Nicole and to ask her about her motivation for starting the podcast and her views on the importance of targeted fortification of human milk for preterm infants.

Nicole is the proud mother of William, now 8 years old and a former 23-week preemie infant. Nicole had a complicated pregnancy, followed by an emergency delivery due to a placental abruption. As a Neonatal Nurse she had more knowledge and experience of the Neonatal Intensive Care Unit (NICU) than most NICU parents but being a NICU mother gave her a completely different outlook of the world she thought she knew so well. This profound realization fueled her desire to help other NICU parents by sharing knowledge and empowering them through education, and this is how her podcast was born.

In each episode of her podcast, Nicole provides clear information for NICU parents to learn, grow, and find support. Nicole’s deep empathy and a huge sense of understanding allow her to connect with her audience on a profound level. Her passion for helping others shines through her engaging discussions and thought-provoking topics.

Balancing a full-time career as a Neonatal Nurse Practitioner and being a mother is no easy task. Nicole candidly admits that there are moments when she questions how she can keep juggling all the responsibilities in her life. However, it is during these moments of doubt that the impact of her work becomes apparent. Fellow NICU mothers, inspired by Nicole’s social media posts or podcast episodes, reach out to her and express their gratitude. These heartfelt messages serve as a reminder to Nicole that she is making a real difference in the lives of others.

In one of Nicole’s insightful podcast episodes, titled “The Composition of Human Breast Milk: How Does Preterm, Term, and Donor Milk Vary?”, she delves into the complex nutritional properties of mother’s own milk (MOM). She discusses the significant differences between MOM and donor human milk (DHM) and emphasizes the importance of fortification for the preterm infants. Additionally, she sheds light on the effects of pasteurization on the nutritional composition of DHM.

Scientific literature consistently highlights the benefits of Mothers’ Own Milk for newborn nutrition. However, while MOM provides many advantages, its nutritional content alone may not be sufficient to meet the high nutritional demands of premature infants. This is where targeted fortification plays a vital role. Fortification involves increasing the protein and fat, as well as calcium and phosphorus concentrations in human milk to be fed to the preterm infant, in order to support their optimal growth and development.

We are thrilled to continue our collaboration with Nicole Nyberg as she empowers and educates NICU parents through her podcast. We invite you to listen to Nicole’s podcast episode mentioned above, “The Composition of Human Breast Milk,” and gain a deeper understanding of the critical role targeted fortification plays in providing optimal nutrition for preterm infants.

Nicole’s mission to empower and educate NICU parents is worthy of our applause and support. We encourage you to engage with her podcast, follow her social media posts, and explore her website. By doing so, you contribute to building a stronger and more informed NICU community.

REFERENCES

Cristina Borràs-Novell, , Ana Herranz Barbero, Montserrat Izquierdo Renau, Carla Balcells Esponera, Miriam López-Abad, Victoria Aldecoa Bilbao, and Isabel Iglesias Platas. Inﬂuence of maternal and perinatal factors on macronutrient content of very preterm human milk during the ﬁrst weeks after birth. Journal of Perinatology (2023) 43:52 – 59

Listen on Apple podcast here

Preemie^® Visits the NICU at University Hospital Southampton, UK

2023-06-10

On Friday 2nd June 2023, Preemie^® visited the neonatal unit at the University Hospital in Southampton UK. Louise Donohue, Preemie^®’s Innovation Project Manager had the privilege of visiting the Princess Anne (PA) Neonatal Intensive Care Unit (NICU) in this hospital. The UHS PA NICU is one of the UK’s leading research neonatal hospitals with special focus on preterm nutrition. The main purpose of this visit was to establish what the current process for the fortification of human milk for preterm infants currently is and how the Preemie^® Sensor will integrate into the workflow and improve preterm infants’ nutritional outcomes. Prematurity is not only the leading cause of mortality in children but can also result in devastating diseases such as necrotising enterocolitis (NEC), as well as in long-term disorders and sequelae such as vision and hearing problems. Besides the tremendous impact on the quality of life of preterm infants and their families, the economic burden for the whole society is huge.

Over 6500 very preterm infants (born before 32 weeks gestation) were born in the UK in 2021. Like all infants, mother’s own milk (MOM) is the preferred feed for them. MOM has multiple health advantages including enhanced immunity and neurodevelopmental outcomes. However, preterm infants have increased nutritional requirements compared to full-term infants, and recommendations have been made by the European Society of Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) regarding the optimal ranges for their nutrient intakes when fed enterally (e.g. by mouth or nasogastric tube) have been published and recently updated in 2022. MOM alone does not meet these recommendations. Therefore, maternal breast milk often requires the addition of breast milk fortifier (BMF), a commercial product specifically designed to enhance the energy, protein, mineral, and micronutrient content of breastmilk.

Currently, at the Princess Anne Neonatal Unit maternal breast milk is fortified by adding standard amounts of breast milk fortifier, which means that the NICU team provides a certain amount of the BMF per ml of MOM. These dosing recommendations are based on the assumption that all MOM is the same and provides nutrition in line with reference data for its nutrient content. However, it is well known that a mother’s milk will vary not just from day to day, but also can be different when her preterm infant is first born compared to the weeks that follow. This variability in the ‘real world’ nutrient content of MOM means that adding a standard amount of BMF does not guarantee the ESPGHAN recommendations will be met for all macronutrients (energy, carbohydrate, protein, and fat), and that the actual nutrient content of MOM with BMF added in standard amounts may often fall short of ESPGHAN recommendations. This may lead to subsequent poor growth and risk of poorer long term neurodevelopmental and cardiometabolic outcomes. Furthermore, in some cases, adding a standard amount of BMF to an amount of MOM that already has a higher nutrient content may lead to an excess of macronutrients, increasing the risk of overweight and obesity, or can result in suboptimal ratio of energy to protein, to the detriment of the infant’s growth and metabolism.

The Preemie^® ecosystem enables a rapid and affordable analysis of human milk composition and delivers data-driven calculations for the targeted fortification needed to meet the unique nutritional needs of each preterm infant. The system also provides in real-time a time-stamped visualisation and analysis of the infant’s growth-related data and the corresponding nutrition given, thus supporting a retrospective understanding of fortification metrics and growth outcomes.
Preemie^® has partnered with the expert team at UHS PA NICU, on a world-first ground-breaking clinical research study “Validation and clinical testing of the Preemie^® Ecosystem for analysis and calculation of targeted fortification of mother’s breast milk for preterm infants”. This study is being led by Dr. Mark Johnson, the lead for NIHR Southampton Biomedical Research Centre and a neonatologist consultant specialising in preterm nutrition.

The Preemie^® team, represented by Louise, met with Philippa (Pip) Crowley, Neonatal Research Nurse, Eduarda Tavares, Milk Kitchen Assistant, and Carla Smith, Milk Kitchen Assistant. In meeting the team Louise observed fully the complex operation involved with the preparation of mother’s own milk (MOM) and Donor Human Milk (DHM) for the preterm infants that they take care of in the NICU. The Preemie^® team was astounded by the sheer dedication, care, and compassion the hospital team showed. Louise’s first comment while observing the Milk Kitchen team was “I am blown away by the magnitude of what goes on in this little kitchen that most people have absolutely no idea about, you have such a big and responsible job that can save the lives of these small infants”. The importance of this process is vital to ensure these preterm infants get the nutrition needed in their first few weeks of life to give them the best chance to survive and to thrive. The milk kitchen team were very generous with their time and expertise and gave the step-by-step process of the standard milk fortification and preparation they follow daily.

The nurses were equally generous with their time and expertise. Pip showed Louise around the NICU explaining the different nurseries & the vital lifesaving care given to give the preterm infants the best chance of survival. There are four nurseries in total, with 36 beds, the high-dependency nursery has 8 beds, where one-to-one nursing care is given, and astonishingly any surgeries required by the infant are performed at the bedside by the team of highly skilled surgeons. Two of the nurseries have 6 beds, and then the final nursery that all families want to get to; the 16-bed nursery where each infant will spend their last days in the NICU before being discharged home. The care is then transferred to the home team, which supports each family with the transition from hospital to home. The NICU is located on level D at the Princess Anne Hospital, UHS was not purpose-built to accommodate a NICU, it has been adapted to make use of the space available. The Preemie^® team felt a real sense of the happiness and love in the unit by walking around and speaking to different members of the team (60 on each shift).

As we discussed in previous blogs, it is highly researched that mother’s own milk (MOM) is best and the team in this NICU agrees with this theory, and so encourages all mums in their care from delivery (as little as 24 weeks) to express their milk 8 times per 24 hours. If MOM is not available all infants less than 33 weeks are recommended to use Donor Human Milk (DHM), which has a better nutrient content than formula milk. UHS has a donor milk bank on site which is an excellent facility that we will feature in a future blog.

Please stay tuned for the next Blog instalment on the UHS NICU & Preemie^® team visits!

The Preemie^® clinical validation study project will bring together innovative human milk analysis (the Preemie^® Sensor), target fortification software (NutriNTrack) to achieve individualised feeding protocols in the UHS NICU in a seamless care pathway. The goal of this project is to provide individualised targeted fortification treatment to improve the nutritional value content of the milk, be that MOM or DHM that the infant receives to enhance the overall health outcomes for each preterm patient. All preterm infants deserve the right to individualised care to meet their specific nutrition needs.

Maternal Mortality

2023-04-22

Maternal mortality is a critical problem in public health that affects women worldwide, and the rate has increased post-COVID. In the US alone, the maternal mortality rate for 2021 was 32.9 deaths per 100 000 live births, up from 23.8 in 2020 and 20.1 in 2019. This mortality refers to a woman dying from any reason connected to or aggravated by the pregnancy or within 42 days of the termination of the pregnancy. According to estimates from the World Health Organization (WHO), over 295,000 women die worldwide each year from problems related to pregnancy and delivery, and unfortunately, 94% of these deaths take place in low- and middle-income nations. This indicates that a woman passes away from pregnancy or childbirth-related problems every two minutes. Although the vast majority of these fatalities take place in underdeveloped nations, maternal mortality is still a serious problem in industrialized nations. Progress is being made to reduce maternal mortality rates globally, but there are still many challenges that women face during pregnancy and childbirth, both in developed and developing countries.

The higher number of maternal deaths during the past recent years, is due to the fact that the COVID pandemic disrupted health services, reducing access to maternal healthcare, and limiting mobility due to lockdowns and travel restrictions. Reduced staffing and resources for maternal healthcare due to hospitals being overwhelmed with COVID-19 patients has further compounded the issue. On top of this, the additional fear of pregnant women contracting COVID-19 in healthcare settings has led to delayed diagnosis and treatment of pregnancy and childbirth complications.

Many women even in developed nations still lack access to high-quality care during pregnancy and childbirth. This is due to the fact that there aren’t enough healthcare providers, particularly in rural locations, or to lack of proper transportation to the healthcare facilities nearby. Sadly, there are racial and ethnic differences in healthcare access and outcomes, with non-caucasian women in the US and UK experiencing disproportionately high rates of maternal mortality.

Another challenge is the increasing number of cesarean sections (C-sections) being performed. Although C-sections can be a life-saving procedure, they are overused in many developed countries. Childbirth is often seen as a medical event, rather than a natural process, which contributes to the overuse of C-sections. C-sections can lead to more complications for both the mother and the baby, an increase in healthcare costs, and ultimately increases the maternal mortality rate.

In contrast, when it comes to maternal mortality, underdeveloped nations have unique difficulties. The main issue is that not everyone has access to high-quality healthcare. Women give birth at home frequently in impoverished nations without the aid of trained delivery attendants, such as midwives, which can result in potentially fatal complications. These underdeveloped nations’ healthcare systems frequently lack the tools, and materials, and have a shortage of qualified staff members who can offer adequate care for pregnant women.

Furthermore, pregnant women in developing nations face serious difficulties such as poverty, starvation, and illiteracy, which can also negatively affect maternal health and raise the risk of maternal death. Individuals who are underprivileged or undernourished might not have access to sufficient medical treatment or healthy nourishment during pregnancy, which can cause complications during childbirth.

Many efforts can be made to lower maternal mortality rates on a worldwide scale. First and foremost, there needs to be a focus on expanding access to high-quality healthcare for all women, irrespective of their socio-economic situation or place of residence. This can be accomplished by making investments in the infrastructure of the healthcare system, training more healthcare professionals, and expanding access to family planning and contraception services. Second, women should be more aware of the potential negative effects of medical procedures performed during childbirth, such as C-sections. Finally, increasing maternal health outcomes depends on tackling social determinants of health such as poverty, hunger, and illiteracy.

Maternal mortality is a complex issue that affects women in both industrialized and developing nations. There are still numerous issues that need to be resolved to reduce maternal mortality, but we should work toward lowering maternal mortality rates by making sure that all women have access to safe and healthy pregnancies and by improving access to high-quality healthcare, reducing unnecessary medical interventions, and addressing the social determinants of health. The COVID pandemic also teaches us a lesson that we must not forget that during a pandemic pregnant women may be scared to deliver their babies in environments that do not offer the safety that mothers are looking for when it is time to deliver their infant. Hospitals that are filled with patients that are affected by the pandemic are not the ideal safe place a mother needs, so we should plan for future pandemics to have midwife services available to those women, or to have small clinics, not connected to hospitals, where women can safely deliver their babies.

REFERENCES

World Health Organization. (2019). Maternal mortality. https://www.who.int/news-room/fact-sheets/detail/maternal-mortality
United Nations Population Fund. (2019). Maternal Health. https://www.unfpa.org/maternal-health
United Nations. (2015). Sustainable Development Goals: Goal 3: Ensure healthy lives and promote well-being for all at all ages. https://www.un.org/sustainabledevelopment/health/
Say, L., et al. (2014). Global causes of maternal death: a WHO systematic analysis. The Lancet Global Health, 2(6), e323-e333.
World Health Organization. (2016). Strategies toward ending preventable maternal mortality (EPMM). https://www.who.int/maternal_child_adolescent/topics/maternal/epmm/en/
United Nations Population Fund. (2017). The State of the World’s Midwifery 2017: The Power of Midwives. https://www.unfpa.org/swop-2017
Ahmed, S., et al. (2015). Challenges in reducing maternal mortality in Pakistan: the need for focus on skilled attendance at delivery. PloS One, 10(4), e0119190.
Villar, J., et al. (2016). Maternal and neonatal individual risks and benefits associated with caesarean delivery: multicentre prospective study. BMJ, 354, i4711.
Campbell, O. M., & Graham, W. J. (2006). Strategies for reducing maternal mortality: getting on with what works. The Lancet, 368(9543), 1284-1299.
Kassebaum, N. J., et al. (2016). Global, regional, and national levels of maternal mortality, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015. The Lancet, 388(10053), 1775-1812.
Lancet Global Health. “Impact of the COVID-19 pandemic on maternal and child health.” 2021. https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(21)00090-2/fulltext

Enteral vs parenteral nutrition

2023-03-03

Premature babies are born before the completion of 37 weeks of gestation. These babies are at a high risk of developing nutritional deficiencies, which can have long-term consequences on their growth and development. Nutritional support is, therefore, essential for these babies, and there are two main routes of administering nutrients to premature babies: enteral and parenteral nutrition.

Enteral nutrition involves administering nutrients directly into the baby’s gastrointestinal tract, either through oral or nasal feeding. On the other hand, parenteral nutrition involves administering nutrients directly into the baby’s bloodstream through an intravenous line.

As enteral nutrition involves delivering nutrients directly into the gastrointestinal tract, this method is usually used when premature babies have a gastrointestinal tract that is functional and can absorb nutrients. On the other hand, when some infants are born very premature and their gastrointestinal tract is not developed enough, neonatal professionals choose the parenteral feeding method, while the gastrointestinal tract is not functioning properly.

There are several differences between enteral and parenteral nutrition, and each method has its advantages and disadvantages.

In conclusion, both enteral and parenteral nutrition have their advantages and disadvantages when it comes to feeding premature babies. Enteral nutrition is generally preferred over parenteral nutrition because it promotes gastrointestinal development and feeding tolerance while reducing the risk of infections by building a healthy microbiome. However, parenteral nutrition may be necessary in cases where enteral nutrition is not tolerated or when a more customized nutrient composition is required. The choice of feeding method should be made based on the individual baby’s needs and medical condition, with close monitoring and management by healthcare professionals.