Background Enteral nutritional supplementation is widely used in preterm babies on Neonatal Units (NNUs). Common forms include breast milk fortifiers (BMF), multivitamins, folic acid and iron. There is little published evidence on evaluating their long term efficacy in preterm babies. Moreover, there are no clear indications of which preterm babies might benefit from these supplements and when they should be started and discontinued. There are no national guidelines on their use, with many NNUs setting their own standards.
Aim To evaluate the current practice of enteral nutritional supplementation in level 2 and 3 NNUs in England.
Methods A total of 113 level 2 and 3 NNUs in England were identified and contacted by telephone. A standardised questionnaire was used to ask neonatal nurses, advanced neonatal nurse practitioners or doctors about current practice of enteral nutritional supplementation on their unit. A response was obtained from 96/113 (85%) of NNUs.
Results BMF, iron, multivitamins and folic acid supplementation were used in 96%, 98%, 98% and 56% of units respectively. Iron, multivitamins and folic acid supplementation were routinely commenced in babies < 35 weeks gestation by 73%, 68% and 39% of NNUs respectively. Iron supplements were commenced on day 14, 21 or 28 in 7%, 11% and 69% of units respectively. 49% of units commenced multivitamins when babies are on full feeds while 24% started on day 14 and 16% on day 7. 25% of units commenced folic acid when babies are on full feeds while 7% started on day 7 and 15% on day 14. 78% of NNUs only use breast milk fortification for babies that are not gaining weight. The majority of NNUs recommended discontinuing nutritional supplements when babies reach 6-12 months of age.
Conclusion Despite being a universal tradition, our data demonstrates continuing variable practice of enteral nutritional supplementation in preterm babies among NNUs across England. Current use of anecdotal evidence and best guess recommendations highlights the need for a unified approach across the UK and collaborative multinational research to produce standardised guidelines.