Well begun is half done Optimizing compositional and practical aspects of neonatal enteral feeding

Nutrition provided in early life is thought to influence later health. Both over- and under nutrition may adversely affect later health outcomes, including the risk of obesitas, diabetes and cardiovascular disease. The most important time frame in which this effect is thought to occur is the intra-uterine growth phase or period after preterm birth, and the milk feeding period after term birth. Both feeding strategy and quality are modifiable factors which can offer opportunities to optimize nutrition. In this thesis we looked into both aspects.
In PART I we focused on the essential amino acid requirement in term and preterm infants, determined by means of the indicator amino acid method. This enables us to optimize future protein quality to match the specific needs of term and preterm neonates, without providing protein in excess.
In PART II we looked into the optimal feeding strategy for improving enteral tolerance of preterm infants and thereby optimizing their intake. Both (semi-)continuous and intermittent nasogastric tube feeding proved to be suitable feeding strategies. Besides, we looked into the relationships between the amount of (fortified) human milk and tolerance and growth. No dose response effect was seen of human milk on tolerance. We therefore speculate that only low amounts of human milk may be needed to induce a beneficial effect on tolerance. An exclusive human milk-based diet, including fortification based on human milk, may be optimal.
Together the studies of this thesis add empirical evidence, which may help optimizing early nutrition and thereby improving later health.