Early, Aggressive Nutritional Management for Very Low Birth Weight Infants: What Is the Evidence?
Section snippets
Observations from Postnatal Growth Studies
In 1948, Dancis and coworkers1 published weight gain curves (Fig. 1) that were derived from 100 preterm infants 1000 g to 2500 g birth weight (BW) plus several infants weighing less than 1000 g at birth who survived. As described, these infants “exhibited no untoward complications in the neonatal period,” and the curves were said to “represent what the premature infant who develops without complications will do when fed and handled in a certain arbitrary manner.” Enteral feedings with a
Nutritional Practice Variation and Growth Outcomes
The impact of nutritional practice variation, within and between centers, on growth outcomes has been described in a number of reports. Olsen and coworkers12 retrospectively studied the weight growth velocities of 564 infants <30 weeks gestation at birth and managed in 6 NICUs between 1994 and 1996. Multiple linear regression models designed to predict weight growth velocity between day 3 and day 28 of age were prepared from center, case mix, medical practices and complications, and nutritional
Evidence Base for Early Parenteral and Enteral Nutritional Management
The limited energy reserves of preterm infants at birth were estimated in a paper written by Heird and coworkers19 over 30 years ago. Using the energy reserves from all available nonprotein plus 1/3 of available protein, and assuming no nutritional supply, the survival time of a 3500-g term infant was estimated to be about 28 days. Preterm infants weighing 2000 g were estimated to have sufficient energy reserves to survive about 10 days, whereas those weighing about 1000 g had about 4 days. By
Evidence-Based Recommendations about Early Nutritional Practices
This overview of the evidence base for early parenteral and enteral nutritional management of VLBW infants has been focused at responding to the question raised above about the need to identify nutritional strategies that will provide the best foundation on which to improve growth and developmental outcomes and to reduce complications and morbidities. Recommendations have been classified according to the quality of the available evidence, as defined in a policy statement by the American Academy
Conclusions
Postnatal growth failure or growth restriction of VLBW, and especially of ELBW, infants is a morbidity that should be vigorously addressed. Achieving the American Academy of Pediatrics Committee on Nutrition goals to provide nutrient intakes that permit the rate of postnatal growth and the composition of weight gain to approximate that of a normal fetus of the same PMA and to maintain normal concentrations of blood and tissue nutrients is considered the best means of facilitating later growth
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Cited by (133)
The association between duration of postnatal weight loss and neurodevelopment outcomes in very low birth weight infants
2022, Pediatrics and NeonatologyCitation Excerpt :Current research indicates that preterm infants can tolerate protein and lipid infusion soon after birth.24–28 Early aggressive nutrition both from the parenteral and enteral routes has been advocated to prevent malnutrition,25,29–32 and it has a positive effect on later neurodevelopment.4,7,8,32–34 Postnatal growth faltering could be diminished by minimizing initial weight loss and ensuring adequate nutrition in patients at risk.35
Gastric Residual Volume in Feeding Advancement in Preterm Infants (GRIP Study): A Randomized Trial
2018, Journal of PediatricsFeeding volume advancement in preterm neonates: A level 4 neonatal intensive care unit quality improvement initiative
2023, Nutrition in Clinical PracticePostnatal growth restriction impairs rat lung structure and function
2023, Anatomical Record