Improving long-term health outcomes of preterm infants: how to implement the findings of nutritional intervention studies into daily clinical practice

Abstract

Preterm-born children are at risk for later neurodevelopmental problems and cardiometabolic diseases; early-life growth restriction and suboptimal neonatal nutrition have been recognized as risk factors. Prevention of these long-term sequelae has been the focus of intervention studies. High supplies of protein and energy during the first weeks of life (i.e., energy > 100 kcal kg−1 day−1 and a protein-to-energy ratio > 3 g/100 kcal) were found to improve both early growth and later neurodevelopmental outcome. Discontinuation of this high-energy diet is advised beyond 32–34 weeks postconceptional age to prevent excess fat mass and possible later cardiometabolic diseases. After discharge, nutrition with a higher protein-to-energy ratio (i.e., > 2.5–3.0 g/100 kcal) may improve growth and body composition in the short term.Conclusion: Preterm infants in their first weeks of life require a high-protein high-energy diet, starting shortly after birth. Subsequent adjustments in nutritional composition, aimed at achieving optimal body composition and minimizing the long-term cardiometabolic risks without jeopardizing the developing brain, should be guided by the growth pattern. The long-term impact of this strategy needs to be studied. What is Known:• Preterm infants are at risk for nutritional deficiencies and extrauterine growth restriction.• Extrauterine growth restriction and suboptimal nutrition are risk factors for neurodevelopmental problems and cardiometabolic disease in later life. What is New:• Postnatally, a shorter duration of high-energy nutrition may prevent excess fat mass accretion and its associated cardiometabolic risks and an early switch to a protein-enriched diet should be considered from 32-34 weeks postconceptional age.• In case of formula feeding, re-evaluate the need for the continuation of a protein-enriched diet, based on the infant’s growth pattern.

Very preterm infants admitted to a tertiary neonatal unit in central Vietnam showed poor postnatal growth

“…Providing adequate nutrition for growth and development is fundamental for the care of premature infants. Early postpartum nutrition has a significant impact on outcomes, including growth, body composition and long‐term neurodevelopment 3,4 . A study of the relationship between the rate of weight gain and neurodevelopment in a cohort of extremely low birth weight (ELBW) infants showed that those who gained 12 g/kg/d had significantly higher rates of cerebral palsy than children with a weight gain of 21 g/kg/d 5 …”

“…composition and long-term neurodevelopment. 3,4 A study of the relationship between the rate of weight gain and neurodevelopment in a cohort of extremely low birth weight (ELBW) infants showed that those who gained 12 g/kg/d had significantly higher rates of cerebral palsy than children with a weight gain of 21 g/kg/d. 5 They also scored less than 70 on the Bayley Scales for Infant and Toddler Development (Second Edition) and had neurodevelopmental defects.…”

Extremely low birthweight neonates with phenylketonuria require special dietary management

“…However, these have not been studied in premature neonates 8,9 . In addition, gene therapy strategies, based on the delivery of the PAH gene via adeno‐associated vector, have been studied 10 . At least partial breastfeeding is encouraged for neonates with PKU.…”

The impact of an early intervention home-based program on body composition in preterm-born preschoolers with very low birth weight

“…A systematic review showed that early intervention significantly affects child development, but it does not affect linear growth, which is more associated with nutritional intervention ( 20 ). The literature describes that nutritional intervention promotes short- and long-term health effects after preterm birth ( 21 ). Moreover, early tactile and kinesthetic stimulation in VLBW preterm children promoted a borderline higher psychomotor development and increased cognitive development assessed at 2 years corrected age, which did not affect weight, length, and head circumference ( 22 ).…”