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“Moderate and late preterm infants deserve more attention”

Pediatric Research (2024)Cite this article

Moderate and late preterm infants (i.e., 32–<37 weeks post menstrual age, PMA) represent the most common preterm population and, despite an overall higher risk for morbidities and mortality than infants born at term, often escape the sequelae of complications experienced by extremely preterm infants. Most preterm infants born after 32 weeks PMA will nearly approximate the weight and length of more mature infants with absent or transient symptoms betraying their immaturity, which allows them to masquerade as healthy term infants. In fact, most late preterm infants (i.e., 34–37 weeks PMA) never visit a neonatal intensive care unit (NICU) and a significant portion of moderate preterm infants (i.e., 32–34 weeks PMA) may experience brief NICU stays.1,2 As such, this population often misses out on the benefits of dedicated guidelines and best practices that are a staple of care for more preterm infants. The relative lack of protocols for older preterm infants means their unique needs may go unmet and leads to considerable practice variation.

Enteral feeding practices are a source of variation that is common to all moderate and late preterm infants. This variation is owed to several factors including the availability of mother’s own milk (MOM) or donor human milk, access to fortifying agents, hospital formularies, regional and cultural influences, and clinician bias among many other unnamed factors. The variation begins almost immediately with decisions regarding the timing, method, and composition of enteral nutrition. In a recent survey of neonatologists and pediatricians, 40% of respondents would initiate enteral feedings with formula for a healthy late preterm infant while 15% would do the same for moderate preterm infants while awaiting the availability of mother’s own milk.3 A small percentage (<10%) of respondents would initiate feeding with donor human milk. Interestingly, intravenous dextrose without enteral nutrition was the most common initial nutritional intervention for both moderate and late preterm infants in this survey. The results of this survey highlight a major limitation in the care of moderate and late preterm infants. Clinicians have few high-quality prospective studies to guide nutrition management in this population. This is a striking realization since 12–15 million infants are born preterm each year4 and preterm births after 32 weeks PMA are 5-times more frequent than births prior to 32 weeks PMA.5,6 While much attention to best practices for nutrition, for example, has been given to extremely preterm infants, substantially less effort is given to these same initiatives in moderate and late preterm infants.

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Funding

The author has received unrestricted grant support from Mead Johnson Nutrition and is a member of the Speaker’s Bureau. The author received in-kind research funding from and is a member of the Speaker’s Bureau for Mead Johnson Nutrition.

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  1. Department of Pediatrics, Augusta University, Augusta, GA, Georgia

    Brian K. Stansfield

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Correspondence to Brian K. Stansfield.

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Stansfield, B.K. “Moderate and late preterm infants deserve more attention”. Pediatr Res (2024). https://doi.org/10.1038/s41390-024-03150-2

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