Optimising nutritional care for premature babies
We have helped develop new guidelines for healthcare professionals, to ensure premature babies get the nutrition they need to grow and develop.

Key facts
Giving premature babies extra nutrition after birth helps them achieve their growth potential
Southampton BRC research shows premature babies grow better if they leave hospital with breast milk fortifier
Dr Mark Johnson was part of two expert groups who produced evidence-based recommendations and guidance for healthcare professionals
Missing a key part of pregnancy
Over the last decade, premature births in England and Wales have ranged between 7% and 8% of all live births. The majority of these (6–7% of all live births) occur at 32–36 weeks of gestation.
Whilst the remaining very preterm births that occur before 32 weeks only represent 1% of all births, this is still 6,500 infants each year.
Babies born prematurely miss out the last part of pregnancy, a period when they grow the most. As a result, infants born prematurely often grow slowly and may end up shorter or with more body fat than those born on time. This increases their risk of problems in later life.
These babies have higher nutritional needs than those born on time. This is because they are missing the last part of pregnancy, which is a time when growth rates are very high, and lack the stores of nutrients that would accumulate in the later part of pregnancy.
Giving them extra nutrition after birth can help them achieve their growth potential. It may also improve the development of their brain and spinal cord. However, we do not know exactly how much nutrition they need to do this.
New recommendations and guidelines
Researchers from Southampton took part in several roundtable discussions, international meetings and literature reviews. These led to consensus statements and guidelines, based on the most recent evidence (including Southampton BRC research), for clinicians caring for premature babies.
The European Society of Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) regularly convenes a group of experts to produce evidence-based recommendations.
Research from Southampton BRC has contributed to the most recent set. Dr Mark Johnson, a neonatologist working for the Nutrition, Lifestyle and Metabolism theme, was part of the expert group making these. In particular, he revised the energy requirements.
The ESPGHAN 2022 preterm recommendations have been used to create an online learning course, which Dr Johnson contributed to. This will aid their uptake by professionals in practice.
While recommendations exist for very premature babies, the nutritional requirements of
moderate and late premature babies are less well known. Dr Johnson chaired a roundtable discussion on this, with a group that included neonatologists, paediatricians, GPs, dietitians, health visitors and midwives. A consensus was achieved and published as guidance for use by healthcare professionals.
This guidance enables healthcare professional caring for these infants to ensure they get adequate nutrition and grow to their potential, which in turn will improve their later outcomes.
Research changing practice
Like all babies, maternal breastmilk is best for premature babies. This is usually given via a nasogastric tube whilst in hospital.
Since breastmilk is not able to fully meet their higher nutritional needs, breastmilk fortifier (BMF) is added to enhance the energy, protein, mineral and micronutrient content.
However, this stops when the babies transition from nasogastric feeds to breastfeeds. This results in a period of suboptimal nutrition and growth.
Pioneering BRC research showed it is possible to continue to give these babies BMF, alongside breastfeeding, after they leave hospital. It found this leads to better growth of these babies at home.
BMF was previously only available in hospital. As a result of this work, BMF has now been approved by the Advisory Committee on Borderline Substances for GPs to prescribe.
The researchers now aim to establish the impact of using BMF in the community, including whether it helps promote breastfeeding.