Nutritional Needs of the Preterm Infant
This resource assists primary care clinicians in monitoring for appropriate nutrition in premature infants after discharged from care in the neonatal intensive care unit (NICU).
Nutritional Components
Energy
- 120-130 kcal/kg/day to grow 15-20 g/day as they catch up to term (potentially more for ELBW).
- The needs decrease as the infant nears 40 weeks gestational age, but the recommendations do not account for “catch up” growth for SGA preterm infants or infants with suboptimal weight gain in the NICU. [Martin: 2006] [Lapillonne: 2013]
Protein
- 2-3 g/kg/day – on the lower end closer to term, on the higher end when around 34 weeks GA. [Lapillonne: 2013]
- However, for ELBW infants, protein requirements are higher and range between 3.5-4.5 g/day. [Mehta: 2009]
Calcium
Iron
- 2-4 mg of elemental iron/kg/day – on the lower end for routine care of late preterm infants.
- Start around 4 weeks of life and continue until approximately 12 months of age or when the child can ingest adequate iron from food or formula. May require monitoring to adjust. [Lapillonne: 2013] There is a lack of consensus on this, however, and consideration must be given to use of iron-containing formulas, fortifiers, multivitamins with added iron, and foods as well as the history of erythrocyte transfusions, as premature infants may also develop iron overload. Common formulations for babies contain 15 mg of elemental iron per 1 mL of liquid. Iron supplementation can cause gastric upset and hard or darkened stools.
Lipids
Vitamin D
- Supplementation is recommended for all infants to help with bone development and other aspects of immune function and development. Typical daily dosing is 400 IU enterally. The Vitamin D3 formulation, cholecalciferol, tends to have more predictable enteral absorption than Vitamin D2, ergocalciferol. Even when a breastfeeding mother supplements her Vitamin D, the levels in breast milk do not meet the recommended daily requirements. Formula-fed babies need to drink at least 34 ounces (1 liter) of formula daily to obtain the recommended daily allowance of Vitamin D. Common formulations of Vitamin D3 for babies contain either 400 IU per 1 mL or 400 IU per drop. Side effects are uncommon; however, some infants find the supplement unpalatable. Please see Calcium and Vitamin D for further information about recommended intakes.
Volume of Feedings
Typically, 150-200 ml/kg/day for infants taking 20 kcal/kg/day, may be decreased for infants taking increased caloric density breast milk or formula or with certain medical conditions requiring volume restriction. [Lapillonne: 2013]
Breast Milk and formula
Breast Milk
Formulas

Laboratory Monitoring
In addition to assessing the infant’s measurements for appropriate growth (see Missing issue with id: 44010697.xml), selective monitoring of blood urea nitrogen, complete blood count with ferritin or reticulocyte hemoglobin, protein markers such as retinol-binding protein* and/or prealbumin, alkaline phosphatase, and/or Vitamin D 25-OH may be valuable in determining the nutritional status of high-risk infants. [Lapillonne: 2013]
*Like prealbumin, retinol-binding protein is a marker of protein stores; its deficiency may also reflect an inflammatory state or Vitamin A deficiency.
Resources
Helpful Articles
Lapillonne A, O'Connor DL, Wang D, Rigo J.
Nutritional recommendations for the late-preterm infant and the preterm infant after hospital discharge.
J Pediatr.
2013;162(3 Suppl):S90-100.
PubMed abstract
Authors & Reviewers
Authors: | Jennifer Goldman, MD, MRP, FAAP |
Sarah Winter, MD | |
Reviewer: | Annette Haban Bartz, MS, RD, LD, CLC |
2014: first version: Jennifer Goldman, MD, MRP, FAAPA; Mary Ann Nelin, MDR |
Page Bibliography
Lapillonne A, O'Connor DL, Wang D, Rigo J.
Nutritional recommendations for the late-preterm infant and the preterm infant after hospital discharge.
J Pediatr.
2013;162(3 Suppl):S90-100.
PubMed abstract
Martin RJ, Fanaroff AA, Walsh MC ed.
Fanaroff and Martin's neonatal‐perinatal medicine diseases of the fetus and infant, Vols I and II.
8th ed. Philadelphia, PA: Elsevier Mosby;
2006.
0-323-02966-3 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2672777/
Mehta NM, Compher C.
A.S.P.E.N. Clinical Guidelines: nutrition support of the critically ill child.
JPEN J Parenter Enteral Nutr.
2009;33(3):260-76.
PubMed abstract
Phillips RM, Goldstein M, Hougland K, Nandyal R, Pizzica A, Santa-Donato A, Staebler S, Stark AR, Treiger TM, Yost E.
Multidisciplinary guidelines for the care of late preterm infants.
J Perinatol.
2013;33 Suppl 2:S5-22.
PubMed abstract / Full Text
Gives guidelines for caring for late preterm infants in the hospital and after discharge. Includes short- and long-term follow
up; each care recommendation is associated with counseling points to share with the family.