Feeding Very-Low-Birth-Weight Infants: Our Aspirations versus the Reality in Practice

Abstract

Recently, new guidelines for enteral feedings in premature infants were issued by the European Society of Pediatric Gastroenterology, Hepatology, and Nutrition Committee on Nutrition. Nevertheless, practice proves difficult to attain suggested intakes at all times, and occurrence of significant potential cumulative nutritional deficits ‘lies in wait’ in the neonatal intensive care unit. This review describes several aspects that are mandatory for optimizing nutritional intake in these vulnerable infants. These aspects range from optimal infrastructure to the initiation of parenteral nutrition with proper transition to enteral breast or formula feedings. Proper monitoring of nutritional tolerance includes serum biochemistry although proper specific markers are unknown and safety reference values are lacking. Although a lot of progress has been made through research during the last few decades, numerous questions still remain unanswered as to what would be the optimal quantity and quality of the various macronutrients. The inevitable suboptimal intake may, however, contribute significantly to the incidence of neonatal diseases, including impaired neurodevelopment. Therefore, it is pivotal that all hospital staff acknowledges that preterm birth is a nutritional emergency and that all must be done, both in clinical practice as well as in research, to reduce nutritional deficits.

Human milk fortification strategies for improved in-hospital growth of preterm infants

“…7,13 This is particularly problematic in those born before 34 weeks gestational age; infants with a birth weight of less than 1800 g; those who are small for their gestational age (SGA); infants with fluid restrictions; and, those with co-morbidities that increase nutrient requirements. 7,9 To illustrate the above, the protein and energy requirements of a 1 kg infant are compared to the nutritional content of mature human milk at volumes typically prescribed for preterm infants. As can be seen from Table 1, human milk at the lower fluid intake of 150 ml/kg body weight/ day does not meet protein or energy requirements as recommended by the American Academy of Paediatrics (AAP) and the European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN).…”

“…7,8 Standard fortification of human milk, that is the addition of fortifier in amounts per volume as specified by the manufacturer, rarely meets the recommended intake of protein, and any shortfall in protein supply is not only growth limiting, but may carry the risk of neurocognitive impairment. [8][9][10] This article proposes to offer an integrative review and critical analysis of fortification strategies of human milk for improved in-hospital growth of preterm infants. In particular, the emphasis is on alternatives to standard fortification.…”

The Impact of the Block Freeze Concentration Process on Human Milk Properties Intended for Feeding Newborns

“…Supplementing human milk with protein is capable of correcting such deficiency [3] [40]. According to Corpeleijn et al [41], the European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPHGAN) recommends that the supply of proteins for newborns with less and more than 1 kg should be between 3.6 -4.1 and 3.2 -3.6 g/100g, respectively. Thus, the addition of the C2 obtained in this study to the milk of donors could satisfy the recommendation of protein intake of preterm neonates.…”

“…Human milk carbohydrates are highly significant for newborns. Apart from providing energy, Moura [46] states that such carbohy- referred by Corpeleijn et al [41] with respect to the total carbohydrates recommended for preterm neonates, i.e., between 10.5 and 12.0 g/100g. Table 2 shows the results for protein, lipid and total carbohydrate contents for human milk, the concentrated and ice fractions.…”

A nutrição adequada pode melhorar o prognóstico dos neonatos prematuros

“…Therefore, as deficient neonatal nutrition (especially during the first days of life) is acknowledged to affect prognosis decisively, the literature-expressed opinion that a premature birth should be attended to by neonatal intensive care unit (ICU) teams as a nutritional emergency is fully justified. (8) Although there is a consensus that the aim of nutrition therapy is to achieve growth similar to fetal growth rates, the current knowledge on the actual nutritional needs of premature infants is fragmented and unable to answer to some relevant questions. Most of the studies involved stable premature infants, and little is known about the metabolic particulars and the impact of some diseases on the nutritional requirements.…”