How to feed small for gestational age newborns

Abstract

Feeding small for gestational age (SGA) newborns is extremely challenging and the neonatologist should be brave and cautious at the same time. Although these babies have a high risk of milk intolerance and necrotising enterocolitis, enteral feeding guidelines are not well established and practice varies widely among different neonatal units. Currently available studies on this topic include extremely and very low birth weight neonates, but are not focused specifically on small for gestational age infants. This review analyzes papers focused on feeding interventions in order to provide the best available evidences about the optimum timing for introduction of enteral feeding, how fast feed volume can be advanced, which milk and which feeding method is more appropriate in SGA infants.

Bolus vs. continuous feeding to optimize anabolism in neonates

“…These results are supported by previous studies showing that preterm infants who receive bolus feeding exhibit marked cyclical surges in hormone levels (33). Furthermore, we showed that continuous feeding increases muscle protein synthesis compared to fasting (Figure 3; 32), consistent with the demonstrated ability of continuous feeding to promote growth (14), but the increase in protein synthesis is greater after an intermittent bolus meal.…”

Proactive Enteral Nutrition in Moderately Preterm Small for Gestational Age Infants: A Randomized Clinical Trial

“…[12][13][14] Although preterm SGA infants are considered to require a higher energy supply than appropriate for GA infants, enteral feeding guidelines are not well established for preterm SGA neonates, and no published information on the optimal feeding regimen is available. 5 Our randomized controlled trial assessed the efficacy of a PFR in reducing the hospital LOS in a population of moderately preterm SGA infants. To our knowledge, only 1 previous retrospective and comparative study has evaluated the effects of 2 different nutrition policies for feeding SGA infants.…”

“…4 Therefore, there is little agreement on how to feed SGA infants, the appropriate feeding volumes, and the rate of feeding advancement. 5 There is some evidence suggesting that a relatively more rapid advancement of enteral feedings in preterm infants could improve growth and decrease the need for intravenous (IV) infusions, without increasing the risk of necrotizing enterocolitis. 6,7 The present study investigated the efficacy of a proactive feeding regimen (PFR) in reducing hospital length of stay (LOS) in a population of moderately preterm SGA infants.…”

Total energy intake accounts for postnatal anthropometric growth in moderately/late preterm infants

“…SGA infants often require more energy because they are predisposed to growth restriction, poor cognitive performance, and neonatal hypoglycemia due to hyperinsulinism or reduced glycogen and fat storages [4,5,12].…”