Meeting the nutritional needs of a pre-term infant


Babies born alive before 37 weeks of pregnancy are referred to as pre-term infants, and health experts say such babies’ nutrition matters a lot as far as their development is concerned.

 Dr. Iba Mayale, an obstetrician and gynecologist in Kigali says to understand pre-term infants, it’s ideal to know that there are sub-categories of pre-term birth based on gestational age.

For the extremely pre-term, he says, refers to those born before 28 weeks, while very preterm they are those born 28 to 32 weeks; moderate to late preterm  (32 to 37 weeks).

Joseph Uwiragiye, head of the Nutrition Department at University Teaching Hospital (CHUK) says during the first year of these babies’ life, good nutrition is essential to healthy growth and development.

He explains that for these infants to grow appropriately, they need adequate calories, protein, and essential nutrients, thus important to ensure they are well taken off as far as nutrition is concerned.

“It’s ideal for both health workers and parents to understand that pre-term infants have distinct physiological characteristics compared to term infants. For this reason, they require high and unique nutritional needs,” he says.

What they should feed on

Uwiragiye says for pre-term infants, human milk is highly preferred noting that relying on it alone cannot fully cover their nutritional needs and optimal growth and development.

An additional protein supply needs to be provided for early catch-up growth, compensating for the cumulative protein deficit developed during the first weeks of life.

Also, the nutritionist says that an increase in the protein-energy ratio is mandatory to improve lean body mass accretion and to limit fat mass deposition.

However, he is quick to add that the fractional nitrogen absorption rate and protein efficiency vary according to the feeding regimens.

Uwiragiye says protein is the main driving force for growth and brain development. Since deficits in protein occur from the first day of extra-uterine life, he says that sufficient quantities of parenteral amino acids should be provided from the first hours of life.

With protein and carbohydrates, nutritionists advise that enough energy should also be provided, via concomitant early administration of intravenous lipid emulsions.

 Studies recommend intakes for premature infants 26 to 30 weeks postconceptional age to be 3.8 to 4.4 g of protein/kg/d with a protein/energy ratio between 3.0 to 3.3 g/100 kcal.

This however, should be according to their relative postnatal growth restrictions and should decrease progressively up to the time of discharge.


 Mayale says the goals of early nutrition in preterm infants are to provide all the necessary vital nutrients, achieve extra-uterine growth rates similar to fetuses of the same gestational age.

Also, he notes that this is vital because it helps support functional neurodevelopment outcomes that are comparable to those of infants born at term.

Meanwhile, Mayale says it is vital to provide nutrition that will maximally support brain growth and development, cautioning that over-feeding with fat accumulation and long-term metabolic consequences should be avoided.

“Premature babies have not been in the womb long enough to store up the nutrients they need and must usually take some supplements,” he says.

He goes on to note that babies who are given breast milk may need supplement milk called human milk fortifier mixed into their feedings, which according to him gives infants extra proteins, calories, iron, calcium, and vitamins.

Because the morbidity associated with prematurity increases nutritional and energetic demands, the basic approach is of providing early intensive nutrition.

 In a nutshell, Mayale says early initiation of enteral feeding with advancement to full enteral nutrition is associated with better maturation of the gut and better neurodevelopmental outcomes.