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A major concern for those taking care of preterm infants is to ensure that nutritional intake meets requirements, thereby ensuring that poor nutrition is not rate limiting on outcome. However, establishment of an adequate intake is difficult during early life in the sick infant. Dietary needs also vary, depending on maturity and nutritional and clinical status. Furthermore, measures of outcome are not widely agreed on. This paper will briefly review some of the principles involved and address some of the practical questions that arise on a day to day basis during nutritional care of these high risk infants.
Determination of nutritional requirements
Recommended dietary intakes are based on needs for maintenance and growth and the assumption that postnatal growth approximates that in utero at the same post conceptional age.1 However, recommended intakes take time to establish, and, having been established, are commonly interrupted for clinical reasons during the first three to four weeks of life in preterm infants.
Figure 1 illustrates this situation more clearly. Embletonet al 2 compared actual and recommended dietary intake (energy 102 kcal/kg/day; protein 3.0 g/kg/day) in a group of preterm infants (⩽ 34 weeks gestation) during the initial hospital stay. By 7 days of age, infants had developed major deficits in energy (∼400 kcal/kg) and protein (13 g/kg), which were not recovered by the time of discharge from hospital; the more immature the infant the greater the deficit at discharge.2
Actual and recommended dietary intake (energy (A) and protein (B)) in a group of preterm infants during the initial hospital stay. *p<0.001. Data taken from Embleton et al.2
It has therefore been suggested that dietary intake must also meet needs for “catch up” growth.3 Whether or not this can be accomplished before hospital discharge remains to be determined, but closer attention must be paid to …