Historical Perspectives

Introduction

In 1985, Thomas E. Cone, Jr, published his book History of the Care and Feeding of the Premature Infant. (1) In it, he provides a detailed historical perspective of the management of infants in the preceding century. One of the areas that set pediatricians apart in the first half of the 20th century was the attention they gave to feeding and nutrition. However, feeding the preterm infant was long considered a difficult task, with many differing opinions. In a recent Historical Perspectives, we highlighted how some of the difficulties were circumvented by the introduction of total parenteral nutrition, with a commentary by Heird and Driscoll. (2)

This month’s perspective is provided by Dr. Pamela Davies, who collaborated with Dr. Victoria Smallpeice to introduce very early enteral feeding with human milk in preterm infants in 1964. (3) With the benefit of 40 years of hindsight, it may be difficult to appreciate how “against the grain” this approach was. Dr. Davies has been retired for more than 10 years now, but recalled their original contribution in an article published in 1991, (4) a significant portion of which (at her suggestion) we produce (with permission).

Although parenteral nutrition remains the preferred method for early feeding of the extremely low-birthweight infant (<1,000 g), an increasing tendency in recent years has been to introduce small amounts of enteral feeding to these tiny babies early in the postnatal period. Such “minimal enteral” or “trophic” feedings seem to provide benefits such as improved milk tolerance, better postnatal growth, and reduced rates of sepsis. (5) The research by Smallpeice and Davies dealt with babies whose birthweights were 1,000 to 2,000 g. In the upper half of this weight category, it is now “standard practice” to provide early feeding with human milk. We are pleased to highlight …