This is a multiauthored book with contributions from dietitians, specialist nurses, biochemists and a speech and language therapist. It is well presented and very clearly written, with useful tables, diagrams and pictures. A summary of key points and recommendations precedes each chapter. The text is well referenced, with a list of references and further reading suggestions at the end of each chapter. It is also evidence based, and the need for further research in a number of areas is highlighted. A glossary and resource list are included as appendices.
A chapter discussing the benefits of breast milk for the preterm infant considers both the short-term and long-term consequences of early feeding method. The section on nutritional requirements includes macronutrients and micronutrients as well as substances such as long-chain PUFA, ß-carotene and nucleotides, which may be conditionally essential for the preterm infant. Ensuring the adequacy of human milk for the preterm infant discusses matters such as donor milk and the handling of expressed breast milk, as well as methods of supplementation.
Enteral feeding includes a section dealing with minimal enteral feeding as well as prebiotics and probiotics for the preterm infant. It is, however, unclear in this chapter whether the recommendations are for breast-milk-fed or formula-fed infants, or indeed whether there are differences in recommendations between the two.
Mammary physiology and milk production, and milk expression each have a chapter devoted to them, and a practical chapter on milk-banking is invaluable for anybody thinking of setting up such a facility. The transition from tube to breastfeeding and cup-feeding is covered in a practical way, and the chapter on feeding development provides the reader with excellent background information.
Measurement of growth, the use of growth charts, the effects of poor growth and strategies for managing suboptimal growth are all efficiently dealt with; post-discharge nutrition and feeding are included in the growth chapter, although the section on weaning is disappointingly brief. The author of the chapter has produced a weaning policy document for her unit, and it is a pity that this could not be shared more fully, as this is a controversial area that causes carers and health-care professionals concern. There have been a small number of studies in this area that were not presented or discussed.
The chapter on feeding problems discusses the effect of enteral feeding tubes, non-nutritive sucking and dummies and feeding equipment, providing useful background information as well as practical advice on overcoming problems.
The final chapter deals with benchmarking, audit and education and is an unusual addition to a nutrition textbook. It contains practical information that those responsible for the management of feeding in a special care baby unit or who provide education for other health-care professionals are unlikely to find anywhere else.
One criticism that could be levelled at the book is that the emphasis is very heavily on infants who are breast fed. Although the book very clearly sets out the benefits of breast milk and explains how milk production and nutritional content can be maximised, we unfortunately live in a less than ideal world. In centres that lack the expertise, enthusiasm and commitment of the authors, many mothers choose not to or fail to provide breast milk for their infants. Mothers who are HIV positive are not recommended to breast-feed in Western societies, where breast milk substitutes are readily available. This dilemma is, however, not discussed at all. A chapter on the options for mixed breast-feeding and formula feeding, and a discussion of the relative merits of available formulas, would make this excellent text truly comprehensive.
The book is most suitable for specialist nurses, midwives and health visitors working in special care baby units or following up preterm infants in the community. I certainly think this is a text that all student midwives should have access to. Dietitians who have an input into the care of preterm infants will also find the book invaluable. Specialist registrars and consultant neonatologists may not wish to read the whole book (although probably they should), but they will certainly find parts of it very useful in clinical practice.
