A1 Complementary feeding in preterm infants
Arianna Aceti (email@example.com)
Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
Optimal nutrition in the first 1000 days, from conception to the second year of life, has the potential to shape the individual health status during both childhood and adult life. This is particularly relevant to preterm infants, whose intrinsic immaturity makes nutritional management a daily challenge for the neonatologist.
Very little attention has been paid by scientific research to complementary feeding (CF) for preterm infants, and both the European  and the Italian  guidelines are specifically intended to guide the introduction of solid foods to “healthy term infants”.
A recent survey promoted by the Italian Society of Pediatrics, conducted among primary care paediatricians, has documented a wide variability in clinicians’ attitude towards timing of CF introduction and type of foods proposed to start CF .
As for timing, CF introduction might theoretically follow two different criteria: a 5 kg weight cut-off was originally proposed in the mid-90s in the UK (COMA report ); however, such a minimum weight does not take into account the infants’ development and can be reached very late by infants born extremely preterm. For this reason, a second criterion, which takes into account infants’ age and maturation, has been later proposed by dieticians’ working groups and professional associations in the UK : a temporal window between 5 and 8 months uncorrected age has been identified as the time when virtually all former preterm infants should have acquired the developmental skills which allow the consumption of foods other than milk, such as the progressive disappearance of the protrusion reflex of the tongue, the reduction of reflexive suck in favour of lateral tongue movements, and the gradual appearance of lip seal. Furthermore, this time window is the optimal one for introducing new flavours and textures in term infants, and, even if it is not known how this sensitive period is affected by preterm birth, it is highly likely that the later preterm infants are introduced to new flavours and textures, the less likely they are to accept a wide variety of foods.
Even if no specific guideline is available, there is consensus that the introduction of CF in preterm infants should be strictly individualized, and that the timing should be guided more by the infant’s developmental acquisitions than by nutritional issues. Nevertheless, given the intrinsic risk for preterm infants of extrauterine growth retardation, a careful choice of high-protein, energy- and nutrient-dense solid foods should be performed.
1. Fewtrell M, Bronsky J, Campoy C, Domellöf M, Embleton N, Fidler Mis N, et al. Complementary Feeding: a position paper by the European Society for Paediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN) Committee on Nutrition. J Pediatr Gastroenterol Nutr. 2017;64:119–132.
2. Alvisi P, Brusa S, Alboresi S, Amarri S, Bottau P, Cavagni G, et al. Recommendations on complementary feeding for healthy, full-term infants. Ital J Pediatr. 2015;41:36.
3. Baldassarre ME, Di Mauro A, Pedico A, Rizzo V, Capozza M, Meneghin F, et al. Weaning time in preterm infants: An audit of italian primary care paediatricians. Nutrients. 2018;10:1–6.
4. Weaning and the weaning diet. Report of the Working Group on the Weaning Diet of the Committee on Medical Aspects of Food Policy. Rep Health Soc Subj. (Lond). 1994;45:1–113.
5. King C. An evidence based guide to weaning preterm infants. Paediatr Child Health (Oxford). 2009;19:405–414.