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Preventing bioenergetic failure in the preterm infant
  1. Camilia R Martin
  1. Correspondence to Dr Camilia R Martin, Department of Neonatology and Division of Translational Research, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Rose-318, Boston, MA 02215, USA; cmartin1{at}bidmc.harvard.edu

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The failure to match postnatal nutritional requirements to support growth and well-being in the extremely preterm infant has been a long-standing challenge with slow progress. Several large prospective cohorts over the past 15 years demonstrate a high incidence of extrauterine growth restriction despite more recent improved nutritional delivery.1 ,2 Furthermore, a direct relationship exists between growth attainment and growth velocity and common neonatal morbidities such as bronchopulmonary dysplasia (BPD), necrotising enterocolitis (NEC), late-onset sepsis (LOS) and neurodevelopmental impairment (NDI).3 An ideal indicator of nutritional effectiveness is a physiological measure that accurately represents the health benefits attained as a result of nutritional intervention in a clinical setting. Growth and growth velocity alone remain imprecise indicators of nutritional effectiveness as they still leave the neonatologist unguided in fine-tuning nutritional delivery at the bedside to ensure optimal postnatal growth and health outcomes.

The iterative studies that have defined the quantity and timing of postnatal protein requirements to maintain a positive nitrogen balance are examples of research efforts that need to be replicated for other elements in nutritional delivery. Precise and deliberate preclinical and clinical interrogations of nutrients and their associated measures of nutritional effectiveness are essential to generate guidelines that are clear and offer greater potential for adherence in the clinical setting. The study by Stoltz Sjöström et al4 extends the previously reported association between growth and retinopathy of prematurity (ROP) by attempting to understand the contribution of other measures of nutritional delivery to ROP risk. Their results add to the nutritional literature that links the importance of total energy and macronutrient delivery to the risk of morbidities diagnosed in the neonatal intensive care unit.

The authors emphasise three findings: (1) total energy delivery was indirectly associated with the risk of severe ROP; (2) of the nutritional macronutrients, the risk …

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