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Introduction of complementary feeding in preterm born infants

This question was posted the Management of small and nutritionally at risk infants under six months and their mothers (MAMI) forum area and has 2 replies.

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Mathieu Nemerimana

Normal user

18 May 2022, 08:06

Many health care workers and community health workers do ask us about what is recommended on when to introduce complementary feeding on preterm infants particularly very preterm born infants. What are the guidelines or recommendations for introduction of complementary feeding to very preterm and late preterm infants?

Alice Burrell

Save the Children

Technical expert

26 May 2022, 10:51

Hi Matheiu,

There appears to be no clear recommendation when it comes to the timing of introduction of complementary foods for premature infants. Two critical considerations are that often information on gestational age is missing in practice – so it is really important that assumptions are not made that a baby is premature just because a baby is small. Secondly, that knowing if an infant is premature OR LBW is critical given the risks and related issues vary.

There are 2 systematic reviews which I have found looking at this topic that may be useful to read: 

1. Complementary Feeding in Preterm Infants: A Systematic Review, 2020: (Note. Included countries seem to be mostly European and risks of early CF will be considerably different than in LMICs)

Conclusions: The available literature does not provide specific guidelines on the management of CF in preterm infants, who are generally weaned earlier than term infants. There is a paucity of data regarding the relationship between CF and growth/quality of growth and health outcomes in preterm infants. It could be suggested to start CF between five and eight months of chronological age if infants have reached three months corrected age and if they have acquired the necessary developmental skills. An individualized multidisciplinary intervention is advisable for preterm infants with oral dysfunctions.

2. The Timing of Initiating Complementary Feeding in Preterm Infants and Its Effect on Overweight: A Systematic Review, 2018:

Key Messages: No clear conclusion could be drawn from the included studies. This review illustrates the need for further research to access the effect of the timing of initiating complementary feeding on overweight in preterm infants.

I hope some of this is helpful, although not conclusive.

Mathieu Nemerimana

Normal user

30 May 2022, 22:03

Thank you Alice for the response and resources

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