Pre-term/low birthweight babies

The phrase ‘pre-term’ applies to babies born before 37 weeks of pregnancy. Pre-term babies have minimal body reserves of nutrients and immature body systems

A significant proportion of a baby’s weight gain occurs between weeks 36 and 40 of pregnancy. Therefore pre-term babies, who are born before this stage of pregnancy, tend to have a lower birthweight and will fall into one of the categories in the table below.

Appropriate nutrition for pre-term babies is important to enable growth at the same rate as a baby in the womb. Pre-term babies have minimal body reserves of nutrients, and immature body systems (e.g. a lack of digestive enzymes). This means they have increased requirements for energy, protein, vitamins and minerals – both for new tissue development and for catch-up growth.

Pre-term babies will usually be in hospital and may need to be fed intravenously (total parenteral nutrition – TPN) or via a tube (enteral nutrition) because babies born at less than 34 weeks are unable to suck properly.

Breast milk fortifiers

Breast milk is the preferred form of feeding for pre-term babies because it provides nutritional, immunological, gastrointestinal, physiological and developmental benefits. It has been shown to have an impact on the long-term health and development of preterm babies. Mums are encouraged to express their milk as soon as possible if they are not able to breastfeed, so the milk can be used for enteral feeding.

Many pre-term babies – especially those who have a very or extremely low birthweight – cannot tolerate large quantities of breast milk and may not receive the nutrients they need. Breast milk fortifiers (e.g. SMA Breast Milk Fortifier, Cow & Gate Nutriprem Human Milk Fortifier) are powder supplements that can be added to expressed or donor breast milk to provide calories, vitamins, minerals and protein. These are for hospital use only.

Suitable formulas

When breast milk cannot be used, an infant formula milk that has been designed to meet the needs of pre-term infants can be used (e.g. SMA Pro Gold Prem 1, Cow & Gate Nutriprem 1). These meet the latest guidelines on pre-term nutrition and contain the energy and nutrients required by pre-term babies in a smaller volume than breast milk. Available in ready-to-use bottles, which reduces the risk of bacterial contamination, they are for hospital use only.

Post-discharge formulas

There are no definitive guidelines on when a pre-term formula should be discontinued. When pre-term babies go home from hospital, they may still weigh less than average full-term babies, so will need to continue rapid growth.

Formula-fed babies may switch to a post-discharge formula such as Cow & Gate Nutriprem 2 or SMA Pro Gold Prem 2. These provide additional nutrients for pre-term infants and bridge the gap between specialist formulas and full-term infant formula milks. Available on prescription, they can be used until six months corrected age. 

When to refer to the pharmacist

This section has covered basic information about the use of specialist milks. As these are used for specific conditions, it is likely that parents will have already seen their GP or health visitor. However, you should confirm this. Customers who ask for advice about the use of specialist milks should be referred to the pharmacist or pharmacy technician.

Foods for special medical purposes should only be used under medical supervision after full consideration of the feeding options, including breastfeeding. They are suitable for use as the sole source of nutrition for infants from birth, and/or as part of a balanced diet from six to 12 months. Refer to labels for details.


Now see what the experts say about specialist milks.

Originally Published by Training Matters