The nutrition of preterm infants

doi:10.1016/j.earlhumdev.2011.12.020

Early Human Development

Volume 88, Supplement 1, March 2012, Pages S5-S7

https://doi.org/10.1016/j.earlhumdev.2011.12.020 Get rights and content

Abstract

Although great efforts have been made to improve neonatal nutrition in very low birthweight (VLBW) infants, many do not receive adequate nutrient intake and thus develop extrauterine growth restriction. In order to minimize the interruption of nutrients that occurs at birth, an “aggressive” nutritional approach has been proposed. Parenteral nutrition, which allows the infant's requirements for growth and development to be met, is indicated in infants for whom feeding via the enteral route is impossible, inadequate, or hazardous. In the last few years, great attention has been given to high amino acid supply in VLBW infants from the first day of life in order to avoid catabolism, establish anabolism, achieve in utero protein accretion rates, and promote linear growth. Whenever possible, enteral feeding should commence with human milk, which is the preferred feeding method for all infants, including those born preterm. In order to meet the unique nutritional requirements of VLBW infants and preserve the singular benefit of breastfeeding, human milk should be fortified to allow adequate growth and bone mineralization. When feeding of preterm infants with human milk is impossible or extremely limited, cow-milk-based formulas for preterm infants must be used.

Introduction

In the last few decades, there has been a significant increase in the survival rate of preterm infants, especially very low birthweight (VLBW) infants. The nutritional problems of preterm babies have become particularly relevant, as numerous studies have underlined the importance of early feeding on short- and long-term development. Many researchers are now determining the most effective nutritional strategies, evaluating which of these strategies, as well as their optimal use, lead to the most effective outcomes in terms of body growth, body composition, and neurodevelopmental outcomes.

Section snippets

Goal of nutrition for preterm infants

The nutritional goals in preterm infants should be to achieve a postnatal growth rate approximating that of normal fetuses of the same gestational age, mimic fetal body composition, and obtain a functional outcome comparable to infants born at term [1].

Unfortunately, although great efforts have been made to improve neonatal nutrition in low birthweight infants, many do not receive adequate nutrient intake and thus develop severe nutritional deficit that affects not only their weight, but also

Is it possible to reduce postnatal growth restriction in VLBW infants?

In order to minimize the interruption of nutrients that occurs at birth, and reduce the interruption of growth and development of preterm infants as much as possible during the first weeks of life, an “aggressive” nutritional approach has been proposed [7]. The term “aggressive” has been used to indicate that nutrient supply is given more rapidly than suggested [8]. The aim of this aggressive nutritional approach is to prevent a catabolic state in the first few days after birth, and later to

Intravenous nutrition

As metabolic and nutritional requirements do not cease at birth, intravenous feeding is always indicated when normal metabolic and nutritional needs are not met by normal enteral feeding. Parenteral nutrition, which allows the infant's requirements for growth and development to be met, is indicated in infants for whom feeding via the enteral route is impossible, inadequate, or hazardous because of malformation, disease, or immaturity.

In order to avoid catabolism, establish anabolism, achieve in

Enteral feeding

Unfortunately, intravenous feeding in preterm infants, especially when prolonged, can induce many adverse effects. The absence of food in the gastrointestinal tract produces mucosal and villous atrophy and reduces the enzymes necessary for digestion and substrate absorption; for this reason, in most preterm infants, early enteral feeding is started the first 1 or 2 days of life. More studies have suggested that associating parenteral nutrition and early postnatal enteral feeding with small

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Cited by (82)

The incidence of and risk factors for hyperglycemia and hypoglycemia in preterm infants receiving early-aggressive parenteral nutrition
2023, Heliyon
Optimizing nutritional support helps prevent extra uterine growth restriction and adverse long-term outcomes in preterm infants.
This study aimed to analyze the incidence of and risk factors for hyperglycemia and hypoglycemia in preterm infants receiving early-aggressive parenteral nutrition (PN).
This prospective observational study included preterm infants receiving PN at the Neonatal Intensive Care Unit of Dr. Soetomo General Hospital between April 2018 and May 2019. Potential risk factors analyzed included asphyxia, sepsis, respiratory distress syndrome, multiple congenital anomalies, mortality, necrotizing enterocolitis, retinopathy of prematurity, the postoperative period, inotropic administration, glucose infusion rate (GIR) > 10–12 mg/kg/min, GIR 4–<5.5 mg/kg/min, and increase in GIR <1 mg/kg/min.
Of the 105 preterm infants included, hyperglycemia and hypoglycemia were found in 14 (13.3%) and 26 (24.8%) infants, respectively, with most incidents occurring in the first week (hyperglycemia: 85.7%; hypoglycemia: 88.5%). Sepsis was an independent risk factor for hyperglycemia (odds ratio [OR]: 8.743, 95% confidence interval [CI]: 2.392–31.959; P = 0.001). Hypoglycemia independent risk factors included the postoperative period (OR: 4.425, 95% CI: 1.218–16.073; P = 0.024) and use of GIR 4–<5.5 mg/kg/min (OR: 2.950, 95% CI: 1.035–8.405; P = 0.043).
Hyperglycemia and hypoglycemia can occur in preterm infants receiving early-aggressive PN; most cases occur within the first week of life. Hypoglycemia correlated with low glucose intake, and hyperglycemia correlated with sepsis. Monitoring blood glucose levels in preterm infants receiving PN, especially in the first weeks of life, may decrease morbidity associated with hyperglycemia or hypoglycemia.
Predicting preterm infants’ length of hospital stay (LOS) using gestational age, birth weight, and early breastmilk feeding
2023, Enfermeria Clinica
The study aims to find a mathematical formula for predicting the length of hospital stay (LOS) of preterm infants with a case study from a hospital in Banyumas Regency, Central Java, Indonesia.
The study uses a retrospective approach with a convenience sample of 96 preterm infants. The outcome variable was the preterm infants’ LOS. The predictor variables were the infants’ gestation, birth weight, and early oral feeding. Data were collected from a medical record at a hospital in Banyumas Regency, Central Java Province, Indonesia. The respondents’ inclusion criteria were preterm infants born before 37-week gestation at the hospital and treated at levels 1, 2, or 3 neonatal care in 2019. The respondents’ exclusion criteria were preterm infants born in another hospital and referred to the hospital because their data were often incomplete. Three experts designed the instrument for data collection with a validation agreement of 100%. The data collection was conducted between March and August 2021. The statistic analysed used univariate analysis, Kolmogorov–Smirnov test, Spearman Rank, linear regression, and ANOVA test.
The mathematical formula for predicting preterm infants’ LOS was y = 64.939 − 1.306 (infant's gestational age) − 0.007 (infant's birth weight) + 1.294 (early oral feeding). The ANOVA test shows that the mathematical formula was feasible to predict preterm infants’ LOS in Indonesia (p = 0.000). The R² was 0.490, which indicates that the mathematical formula could predict the Indonesian preterm infant's length of hospital stay at 49%.
The predictors of preterm infants’ LOS are gestational age, birth weight, and early breast milk feeding. Therefore, nurses at levels 1, 2, and 3 neonatal care should give attention to infants’ gestation and birth weight. Nurses should facilitate early feeding as soon as possible to increase daily weight and shorten the LOS.
Promoting enteral tube feeding safety and performance in preterm infants: A systematic review
2022, International Journal of Nursing Studies
Citation Excerpt :
With few nutrient reserves at birth, preterm infants are vulnerable to physiological and metabolic stresses which increase their nutritional requirements (Walsh et al., 2020). Inadequate nutrition in the neonatal period is a significant contributor to growth failure (Su, 2014), resulting in adverse neurodevelopmental, cognitive, and educational outcomes (Curtis and Rigo, 2012; Leppänen et al., 2014; Nora and Clara, 2017). Providing feeding support for optimal nutrition is therefore a cornerstone of care and survival for preterm infants (World Health Organization, 2018).
Enteral tube feeding is commonly used in preterm infants to provide enteral nutrition. Nurses play a crucial role in promoting feeding safety and performance.
The aims of this systematic review were to identify nursing practices regarding feeding safety and performance promotion in preterm infants with enteral tube feeding and summarize evidence on the effectiveness of these practices.
A comprehensive search was performed in six databases (MEDLINE, EMBASE, CINAHL, Web of Science, Cochrane Library, and Scopus). Studies on nursing practices aimed at promoting feeding safety and performance in preterm infants with enteral tube feeding were included. Risk of bias was assessed using the revised Cochrane risk-of-bias tool for randomized trials (RoB 2) for randomized controlled studies and the tool of risk-of-bias in non-randomized studies of interventions (ROBINS-I) for non-randomized studies of interventions. A narrative synthesis strategy was employed to gather evidence and analyze data.
61 studies (47 randomized controlled studies and 14 quasi-experimental studies) covering seven categories of practices were included. The identified nursing practices included controlling feeding interval, selecting feeding position, monitoring gastric residual, disposing of gastric residual, managing feeding temperature, feeding promotion stimulation, and supplementary methods during the transition from tube to oral feeding. Evidence supported the effectiveness of oro-motor stimulation and non-nutritive sucking as feeding performance promotion strategies in preterm infants. Other practices were suggested to be used cautiously or recommended to be further studied due to limited evidence.
The review identified seven categories of nursing practices in promoting feeding safety and performance in preterm infants receiving enteral tube feeding. Oro-motor stimulation and non-nutritive sucking can be used in clinical settings to promote feeding performance in preterm infants with enteral tube feeding. Other practices will continue to be dictated by local preferences and cost factors until more robust evidence becomes available.
Registration: PROSPERO database (CRD42020196256).
Associated neonatal and maternal factors of osteopenia of prematurity in low resource setting: A cross-sectional study
2021, Annals of Medicine and Surgery
Determining neonatal and maternal factors that are associated with the incidence of OFP.
This study employed a cross-sectional design, in which the participants were identified for clinical variables (sex, gestational age, birth weight, etc.), neonatal morbidity (sepsis, necrotizing enterocolitis (NEC), etc.), and maternal risk factors (premature rupture of membranes, preeclampsia, etc.). The data were analyzed using Chi-square test, independent t-test, and logistic regression test with p < 0.05.
The birth weight ranged from 800 to 1495 g (1219 ± 225 g), of which 5 newborns (17%) were <1000 g. The gestational age ranged from 27 to 32 weeks, with a mean of 29 ± 1.5 weeks. The signs of OFP were observed in 13 (43%) infants, of which 2 (15%) OFP infants had a birth weight <1000 g. There was significant difference in parenteral nutrition duration (p = 0.018), onset of vitamin D supplementation (p = 0.019), and ALP level (p = 0.012) of infants between the OFP group and the non-OFP group. The variables associated with the incidence of OFP were parenteral nutrition duration >15 days (OR = 5.4; 95% CI 1.120–26.044; p = 0.036), ALP level >500 U/L (OR = 2.889; 95% CI 1.703–4.900; p = 0.014), and PROM (OR = 5.4; 95% CI 1.039–28.533; p = 0.045).
The lack of phosphate intake, prolonged parenteral nutrition, ALP level >500 U/L, onset of vitamin D supplementation, and premature rupture of membranes are associated with the incidence of OFP.
Nutrition in late preterm infants
2019, Seminars in Perinatology
Citation Excerpt :
For volume intolerant infants, more energy dense formulas are also available that have more energy in the same amount of fluid.22 When all the nutritional requirements of late preterm infants cannot be met through enteral feeding, particularly if feed intolerance is prolonged or enteral feeding must be withheld for any reason, parenteral feeding can be helpful.25 Parenteral nutrition initiation and advancement should proceed as quickly as tolerated.26
Late preterm infants comprise the majority of preterm infants, yet there are few data to support best nutritional practice for these infants. Breastmilk is considered the best choice of enteral feeding for late preterm infants. However, supplementation of breastmilk may be indicated to promote optimal growth. Preterm formulas can be used for supplementation of breastmilk or as a breastmilk substitute but there is little evidence for their use in the late preterm infant. Feeding difficulties are common and some infants require intravenous nutritional support soon after birth. Others require tube feeding until full sucking feeds are established. Future research should focus on whether nutritional support of late preterm babies pending exclusive breastfeeding influences growth, body composition and long-term outcomes of late preterm infants and, if so, how nutritional interventions can optimise these outcomes.
Biochemical Profiling of Urine Metabolome in Premature Infants Based on LC−MS Considering Maternal Influence
2024, Nutrients

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The nutrition of preterm infants

Abstract

Introduction

Section snippets

Goal of nutrition for preterm infants

Is it possible to reduce postnatal growth restriction in VLBW infants?

Intravenous nutrition

Enteral feeding

Arch Pediatr

Clin Perinatol

Nutritional needs of low-birth-weight infants

Pediatrics

Extrauterine growth restriction in very-low-birthweight infants

Acta Paediatr

Longitudinal growth of hospitalized very low birth weight infants

Pediatrics

Critical periods in brain development