Tolerance of Preterm Infants to Human Milk Fortifier
The major problem found in the development of preterm infants is the enteral feeding intolerance that causes prolonged hospitalization and a predisposition to serious complexities as a result of the prolonged use of parenteral nutrition (Sekteera, Nuntnarumit and Supapannachart, 2002). Enteral feeding intolerance can also contribute to the immaturity of gastrointestinal motility (Berseth, 1989. Ng and Shah, 2001) since small intestinal motility and migrating motor complexes (MMC’s) phase-3 activity are not significantly developed in preterm infants, in particular in those preterm infants whose gestational age is below 32 weeks (Berseth, 1989. Jadcherla, Klee and Berseth, 1997). Migrating motor complex in the upper gastrointestinal tract contributes to the regulation of gastrointestinal motility and also provokes gastric emptying and postprandial gastric muscle contractions (Jadcherla, Klee and Berseth, 1997. Jadcherla and Berseth, 2002).One of the greatest challenges for neonatologists is the fortification of human in relation to both short term and long term benefits however the appropriate nutritional management regime for preterm infants is uncertain and requires further research. The use of human fortified milk is a well-known practice for the nutritional management of preterm infants.Appropriate nutrition during infancy is important for the normal growth, optimal neurologic and cognitive development, long term health and resistance to infection of the preterm infant. However, the provision of this adequate nutrition to the premature infants is a challenge due to various issues which include the inability to suck and swallow, immaturity of bowel function, illnesses and high risk of necrotizing enterocolitis (NEC) that may disrupt the proper enteral feeding, for example, RDS and patent ductus arteriosus and also, the medical interventions such as exchange transfusion, umbilical vessel catheters, and indomethacin therapy that inhibit feeding.