Aggressive Nutrition of the Preterm Infant

Hay, William W.

doi:10.1007/s40124-013-0026-4

Cited by 126 publications

(139 citation statements)

References 97 publications

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“…3 Parenteral nutrition (PN) is an intravenous nutritional therapy that includes the administration of fluids, electrolytes, glucose, proteins, lipids, minerals, vitamins and oligo-elements. 4 It should be started as soon as possible within the first 24 hours of life.…”

Section: Parenteral Nutritionmentioning

confidence: 99%

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Feeding of preterm infants and fortification of breast milk

Mangili

Garzoli

2017

Pediatr Med Chir

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The administration of the adequate amount of nutrients helps to improve a correct short-term linear growth and long-term neurocognitive development. To reduce the extra-uterine growth delay in very low birth weight infants (VLBW) the best strategy of nutrition (parenteral or enteral) should be established rapidly, since the first day of life. In preterm infants, nutrition can be administered parenterally and enterally. Prematurity is the most frequent indication for parenteral nutritional support due to intestinal functional immune deficiency, deficiency of digestive enzymatic systems and reduced nutritional reserve of these infants. In terms of enteral nutrition, breast milk is the first choice. In case of preterm and VLBW infants, fortifiers are used to overcome breast milk's protein and mineral deficiencies. When breast milk is not available, specific infant formula is the alternative. IntroductionThe improvement of neonatal care has led to an increase in the survival rate of very low birth weight infants (VLBW) infants (<1500 g). Nonetheless, growth failure is still a very frequent issue with incidence that ranges from 43 to 97% among various neonatal units. Thus, more aggressive nutritional strategies have been developed: first the parenteral nutrition then the enteral nutrition. Parenteral nutrition is often the only source of nutrients that can be used during the period of clinical instability. 1 Enteral nutrition must be gradually introduced as soon as possible; in presence of a good enteral tolerance, the parenteral nutrition should be rapidly discontinued, thus reducing its related side effects. 2 Parenteral nutritionAssuring an adequate nutrition to preterm infants is a real challenge, especially during the first hours after birth, when a total parenteral nutrition (TPN) is needed to meet the high nutritional requirements but it is often complicated by glucose and lipids intolerance. 3 Parenteral nutrition (PN) is an intravenous nutritional therapy that includes the administration of fluids, electrolytes, glucose, proteins, lipids, minerals, vitamins and oligo-elements. 4 It should be started as soon as possible within the first 24 hours of life. It can be prescribed in individualized or standardized administration; PN is provided through a central catheter (umbilical vein catheter or percutaneous central catheter) or, temporarily, via a peripheral route in the case of partial parenteral solutions and low osmolar load (<600 mOsm/L). Fluids and electrolytesIn the first week of life changes occur in the extracellular and intracellular compartments, resulting in a redistribution of fluids. This is one of the reason that explains the weight loss (5-10% of birth weight) that usually takes place during the first days of life. The fluid intake in the newborn (VLBW) and very low birth weight (ELBW) starts with 80-90 mL/kg/day and then is gradually increased by 10-20 mL/kg/day up to 160-180 and 150-160 mL/kg/day, respectively. 2,5-8 Electrolytic supplementation usually begins on the third-fourth day of...

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Section: Parenteral Nutritionmentioning

confidence: 99%

“…3 Then, small amounts of food (e.g <20 mL/kg/day) are given to promote trophism and stimulate the maturation of intestinal motility. According to specific nutritional protocols (Tables 1 and 2), 19 enteral feeding must gradually increase.…”

Section: Enteral Nutritionmentioning

confidence: 99%

Feeding of preterm infants and fortification of breast milk

Mangili

Garzoli

2017

Pediatr Med Chir

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Section: Introductionmentioning

confidence: 99%

“…4,5 Because growth failure of low birth weight (LBW) infants has been attributed, in part, to the provision of inadequate levels of protein and energy, more aggressive nutritional support is now being advocated. 6 Evidence suggests that this approach is justified because early provision of amino acids to extremely LBW infants is associated with improved growth; 7 moreover provision of adequate amount of amino acid increases whole body protein synthesis and accretion rates in LBW infants. 8 Parenteral feeding allows rapid nutrition when enteral nutrition is not possible due to respiratory problems, limited gastric capacity, reduced intestinal mobility, and a perceived risk for necrotizing enterocolitis.…”

Section: Introductionmentioning

confidence: 99%

“…8 Parenteral feeding allows rapid nutrition when enteral nutrition is not possible due to respiratory problems, limited gastric capacity, reduced intestinal mobility, and a perceived risk for necrotizing enterocolitis. 6 When an infant is medically stable, minimal enteral feeding is provided to prime the intestine and gradually the infant is moved from parenteral to enteral feeding until achievement of full enteral feedings.Enteral nutrition is preferred to total parenteral nutrition (TPN) because the former avoids complications related to vascular catheterization, sepsis, adverse effects of TPN, and fasting. Moreover, enteral feeding in the first days of life promotes endocrine adaptation and the maturation of motility patterns, provides luminal nutrient, and probably benefits immune function.…”

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Enteral nutrition for preterm infants: by bolus or continuous? An update

Bozzetti

Tagliabue

2017

Pediatr Med Chir

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Optimization of nutritional management of preterm infants is crucial for achievement of their long-term health. Enteral nutrition is preferred to total parenteral nutrition (TPN) because the former avoids complications related to vascular catheterization, sepsis, adverse effects of TPN, and fasting. Due to the lack of ability of preterm infants to coordinate suckling, swallowing, and breathing, tube feeding is necessary for most infants less than 1500 g to ensure sufficient feeding tolerance, to support optimal growth and to reduce the risk of aspiration. Therefore, feeding by orogastric or nasogastric tube using either continuous or intermittent bolus delivery of formula or human milk is common practice for these infants. Theoretical risks and benefits of both continuous nasogastric milk feeding and intermittent bolus milk feeding have been proposed. According to the literature, continuous nutrition could be preferred in smaller infants (as those with a birthweight below 1250 g) or hemodynamically impaired infants; in stable growing infants nutrition can be administered intermittently as in healthy term infants. IntroductionApproximately 8% of infants are born with a weight at birth less than 2.5 kg. 1 These infants face uncertain futures, ranging from insufficient postnatal growth to compromised neurodevelopmental outcomes. 2 Thus, optimization of their nutritional management is crucial for achievement of their long-term health and wellbeing. There is a correlation between the neurocognitive outcome and growth, for this reason an adequate nutrition is essential for the optimal growth and health. Most of severe preterm infants are discharged weighing less than the tenth percentile for age despite improvements in their nutritional management. 3 Some of them remain small to adulthood and exhibit adverse long-term developmental outcomes including learning impairments and reduced work capacity. 4,5 Because growth failure of low birth weight (LBW) infants has been attributed, in part, to the provision of inadequate levels of protein and energy, more aggressive nutritional support is now being advocated. 6 Evidence suggests that this approach is justified because early provision of amino acids to extremely LBW infants is associated with improved growth; 7 moreover provision of adequate amount of amino acid increases whole body protein synthesis and accretion rates in LBW infants. 8 Parenteral feeding allows rapid nutrition when enteral nutrition is not possible due to respiratory problems, limited gastric capacity, reduced intestinal mobility, and a perceived risk for necrotizing enterocolitis. 6 When an infant is medically stable, minimal enteral feeding is provided to prime the intestine and gradually the infant is moved from parenteral to enteral feeding until achievement of full enteral feedings.Enteral nutrition is preferred to total parenteral nutrition (TPN) because the former avoids complications related to vascular catheterization, sepsis, adverse effects of TPN, and fasting. Moreover, enteral feedin...

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