Nutritional support for extremely low-birth weight infants: abandoning catabolism in the neonatal intensive care unit

Akker, Chris H.P. van den; Vlaardingerbroek, Hester; Goudoever, Johannes B. van

doi:10.1097/mco.0b013e328337d925

Cited by 27 publications

(20 citation statements)

References 104 publications

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“…A stepwise increase and/or a delayed [13] commencement of nutrient administration inevitably result in the occurrence of considerable deficits during the first few days of life [4]. These deficits have proven to be very hard to recoup and every effort should be made to prevent their occurrence [29]. …”

Section: Managing Nutrition According To the Latest Guidelines Of Thementioning

confidence: 99%

“…For example, reference urea concentrations in the fetus range from 7.5 to 14.3 mmol/l [34]. Effects of higher urea concentrations are unclear [29], although urea concentrations >30 mmol/l were accompanied with slightly elevated ammonia concentrations of around 100 µmol/l in premature infants below 24 weeks of gestation receiving up to 4 g amino acids/kg per day during the first few days of life [35]. However, in most NICUs, urea cutoff values for discontinuing or decreasing parenteral amino acids are much lower.…”

Section: Managing Nutrition According To the Latest Guidelines Of Thementioning

confidence: 99%

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

et al. 2011

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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.

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Section: Managing Nutrition According To the Latest Guidelines Of Thementioning

confidence: 99%

Section: Managing Nutrition According To the Latest Guidelines Of Thementioning

confidence: 99%

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

et al. 2011

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“…Ehrenkranz et al showed that the severity of illness as well as the early nutrition practices are both, independently, associated with both survival and neurodevelopmental outcome at discharge and two years of age [10]. Another study showed that not only psychomotor development improved by giving more protein to preterm infants, also was the incidence of infections lower [24]. At the same time however, there might also be an upper limit to the intake of protein and calories in the neonatal period.…”

Section: Introductionmentioning

confidence: 99%

Nutrition of the preterm infant

P.J.J.

2015

Pediatr (SPb)

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Abstract. Nutrition is of great importance for the preterm infant. It is not only essential for survival, but also makes provision for rapid development of many organs outside the uterus which process normally takes place in the third trimester of pregnancy. It is for future life essential that all factors that might influence the development are as optimal as possible, including nutrition. However, there might also be an upper limit to the intake of some ingredients in the neonatal period. The rate of growth of the preterm infant is five times higher compared to term infants and the breast of the mother delivering preterm might yet be ready to produce the optimal composition of milk. Preterm infants receiving mothers milk only are known to show a lower gain in weight and length than the so called reference fetus. It is therefore at least questionable if preterm human milk can be used to define the nutritional needs of the preterm infant. To define the optimal composition and amounts of nutrients for the preterm infant a factorial approach can be used. The estimated requirements are calculated from the calculated requirements for maintenance and growth. Though some studies have shown that the protein content of milk from mothers who delivered preterm can be higher in the first few weeks after birth compared to milk of term delivering mothers, soon after there is a rapid decline in protein content after which period the content is not different from the term delivered mother. Providing exclusively mothers own milk leads to suboptimal growth and insufficient accretion of minerals. The needs of the preterm infant in energy, protein, lipids, carbohydrates, minerals, pro-and prebiotics to provide optimal nutrition in the first days after birth are discussed in the paper. It is concluded that nowadays early, aggressive nutrition directly after premature birth with the immediate introduction of amino acids and rapid introduction of lipids is advised. Enteral feeding should be started very soon after birth, preferably on the first day of life and increased in the days thereafter. The first choise for enteral feeding is mothers own milk, supplemented from the second week with a fortifier. Special preterm formula might serve as a good alternative in case when breast milk is not available.Key words: preterm infants; nutritional needs; feeding; breast milk; preterm formula. ВскармлиВание недоношенного ребенка© п. дж. дж. Зауэр Университетский медицинский центр в детском госпитале Беатрисы, Гронинген, нидерланды Резюме. питание очень важно для недоношенного ребенка. оно обеспечивает не только выживание, но и характерную для последнего триместра интенсивную динамику внутриутробного развития многих органов вне утробы матери. для дальнейшей жизни важно, чтобы все -в том числе и питание -факторы, потенциально могущие оказать влияние на развитие, были, по возможности, оптимально сбалансированы. однако, для некоторых пищевых ингредиентов, используемых в неонатальном периоде жизни, могут быть и верхние границы потребления. скорость...

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“…Nonetheless, these approaches still leave infants with resultant postnatal growth restriction as reviewed by Ziegler [9]. Postnatal growth restriction has been associated with adverse long-term neurocognitive outcomes [10,11,12,13]. …”

Section: Introductionmentioning

confidence: 99%

Human Milk and the Premature Infant

Bhatia¹

2013

Ann Nutr Metab

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Human milk is the preferred feeding for both term and preterm infants. While being considered optimal for term infants, human milk, even from mothers delivering preterm infants, is lacking in protein, energy, sodium, calcium, and phosphorus, resulting in poorer growth and nutrient deficiencies when compared to formulas designed for these high-risk infants. Further, the lack of growth is associated with long-term adverse consequences. Since human milk has unique properties in promoting gastrointestinal maturation and immunological benefits, it is prudent to implement strategies to fortify it appropriately to realize its benefits which include reduced rates of necrotizing enterocolitis, fewer episodes of sepsis and urinary tract infections, and improved visual and neurocognitive development. Donor human milk is being widely used when mothers' own milk is not available or is in short supply. While it retains some of the biological properties and clinical benefits of mothers' own milk, it requires additional care in fortification, especially if the donor milk is from a pool of term human milk. As nutritional strategies improve, the ultimate goal is to minimize extrauterine growth restriction and promote appropriate growth after regaining birth weight.

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Nutritional support for extremely low-birth weight infants: abandoning catabolism in the neonatal intensive care unit

Cited by 27 publications

References 104 publications

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

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

Nutrition of the preterm infant

Human Milk and the Premature Infant

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