Ask the expert: Jack Huitson, Nutrition and Food Science Milks NutritionistQ. What are the key points of the ESPGHAN 2010 nutritional guidelines for preterm babies?
A. The 2010 ESPGHAN nutritional guidelines1reflect the current knowledge of the nutritional
requirements for preterm infants, with the aim of achieving growth similar to foetal growth together with satisfactory functional development.
The guidelines recommend fortified mother’s milk to meet individual requirements, with
preterm formula as an acceptable alternative. They relate to enteral intakes for stable growing
preterm infants up to a weight of approximately 1800g and provide minimum and maximum
ranges for various nutrients.
“The preferred food for premature infants is fortified human milk from the infant’s own
mother, or, alternatively, formula designed for premature infants.”1
The nutritional recommendations are the same for infants weighing above and below 1000g as the data is lacking to specify different recommendations for premature infants
The number of babies born prematurely makes it important that ESPGHAN guidelines are
adequately disseminated and implemented.
Q. Preterm births have risen throughout the industrialised world over recent years2. What are the reasons and consequences of this rise?
A. According to the World Health Organization2, the worldwide reasons behind preterm birth include behavioural and socioeconomic factors, medical conditions in the mother or foetus, genetic influences, environmental exposure, infertility treatments and iatrogenic prematurity2. The incidence of preterm births in the UK and other industrialised countries is increasing for several reasons,including the preterm delivery of artificiallyconceived and multiple pregnancies2.
The high rates of morbidity and mortality associated with preterm births mean that the increase places new burdens on specialist care services. While most preterm babies survive, they are at increased risk of respiratory and gastrointestinal complications and neurodevelopmental impairment3. A greater emphasis will need to be placed on reducing these risks and improving infant health outcomes. The increase in levels of preterm birth imposes substantial costs to health services, education services and social services. It also has a direct impact on families who must cope with the associated health problems and costs4. Q. What are the advantages of using Bisphenol A (BPA)-free and phthalate-free bottles for infant formula?
A. A. BPA has been known to be estrogenic since the mid 1930s. Concerns about the use of BPA in consumer products were regularly reported in the media in 2008 after several governments issued reports questioning its safety, prompting some retailers to remove products containing it from their shelves.
Phthalates (sometimes referred to as phthalate esters) are mainly used as plasticizers (substances added to plastics to increase their flexibility, transparency, durability, and longevity). Phthalates are being phased out of many products in the European Union, the
United States and Canada over health concerns.
According to feedback from Katie Jones, Senior Midwife and member of the Careline team at Danone Baby Nutrition, mothers are concerned about the effect of these chemicals on their infants’ health. The advantage of using Bisphenol A (BPA)-free and phthalate-free bottles for infant formula is that parents can feel assured that their infant is not being exposed to any of the potential risks associated with the use of BPA and phthalates.
Cow & Gate take these concerns very seriously. Their recent innovative products – bottled
formula milk and standard teats – are made from both BPA-free and phthalate-free materials.
References: 1. Agostoni C et al. Enteral nutrient supply for preterm infants: Commentary from the European Society for Paediatric Gastroenterology, Hepatology and Nutrition Committee on Nutrition. J Pediatr
Gastroenterol Nutr 2010;50:85-91. 2. Beck S et al. The worldwide incidence of preterm birth: a systematic review of maternal mortality and morbidity. Bulletin of the World Health Organization 2010;88:31-38.
3. Goldenberg RL et al. Epidemiology and causes of preterm birth. Lancet 2008;371(9606):75-84. 4. Petrou S et al. The long-term costs of preterm birth and low birth weight: results of a systematic review. Child Care
Health Dev 2001;27(2):97-155.