The former ELBW premie leaves the NICU with a substantial growth and nutritional deficit. Once home, term and preterm infants alike with residual cardiopulmonary or gastrointestinal disease post-intensive care continue to consume a limited volume compared to well peers. These infants need to receive a nutrient-enriched diet for several months post NICU discharge.

The transitional formulas (Similac NeoSure and Enfacare 22) provide 10% more calories, 20% more protein, and 50% more calcium than standard term formulas. Former preterm infants fed such nutrient-enriched formulas until 6 – 9 months corrected age demonstrate better weight gain, linear growth, increased head circumference and increased bone mineral content. Benefits may accrue until 12 – 18 months corrected age. Adequate catch-up growth and head circumference at 8 months corrected age have been clearly shown to correlate with improved neurodevelopmental outcomes.

Therefore, Vanderbilt NICU recommends that formula-fed former VLBW preterm infants, IUGR infants, and infants with chronic illnesses / increased nutrient needs be fed transitional nutrient-enriched formulas until at least 9 months corrected age.

Resolved at Nursery Policy & Procedure meeting 8/16/00; revisited at Nursery Policy & Procedure meeting 2/21/01.

References:

Lucas A, et al. Randomized trial of nutrient-enriched formula versus standard formula for postdischarge preterm infants. Pediatrics 2001; 108: 703-11.

Carver JD, et al. Growth of preterm infants fed nutrient-enriched or term formula after hospital discharge. Pediatrics 2001; 107: 683-9.

American Academy of Pediatrics. "Nutritional Needs of Preterm Infants." In Kleinman RE, ed. Pediatric Nutrition Handbook, 4^th ed. 1998. pg. 55

Carter, BS. Feeding the low birth weight infant and the NICU graduate. The Tennessee Pediatrician, winter 2001:10-11.

Hack M, et al. Effects of very low birthweight and subnormal head size on cognitive abilities at school age. N Engl J Med 1991; 325: 231-37.

Heird WC. The importance of early nutritional management of low-birthweight infants. Pediatrics in Review 1999; 20: e43-e44. http://www.pedsinreview.org/cgi/content/full/20/9/e43