Growth failure in the preterm infant: can we catch up?

Area of Science:

• Neonatology
• Pediatric Nutrition
• Growth and Development

Background:

• Postnatal growth failure is prevalent in very low birth weight (VLBW) and extremely low birth weight (ELBW) infants.
• By 36 weeks corrected age, 89% of ELBW infants exhibit growth failure, with 40% remaining below the 10th percentile at 18-22 months corrected age.
• Growth failure is linked to adverse neurodevelopmental outcomes.

Purpose of the Study:

• To highlight the critical role of postnatal nutrition in preventing growth failure in VLBW and ELBW infants.
• To emphasize the importance of aggressive nutritional interventions during neonatal intensive care unit (NICU) hospitalization and after discharge.
• To underscore the need for further research into nutrition's impact on long-term development.

Main Methods:

• Analysis of data from the National Institute of Child and Human Development (NICHD) Neonatal Research Network.
• Review of nutritional strategies including parenteral and enteral support within the NICU.
• Examination of post-discharge nutritional recommendations, including specialized formulas and fortification for breastfed infants.

Main Results:

• ELBW infants often experience significant protein and energy deficits during NICU stays.
• Aggressive nutritional support (parenteral and enteral) is safe and effective in improving growth for ELBW infants.
• Appropriate nutrition, including fortified human milk or premature formula, is crucial throughout the NICU stay and post-discharge.

Conclusions:

• Inadequate postnatal nutrition significantly contributes to growth failure in ELBW infants.
• Early and sustained aggressive nutritional support is vital for optimizing growth in VLBW and ELBW infants.
• Further research is necessary to fully elucidate the relationship between nutrition, growth, and neurodevelopmental outcomes.