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Growth failure in the preterm infant: can we catch up?
Anna M Dusick1, Brenda B Poindexter, Richard A Ehrenkranz
1Section of Developmental Pediatrics, Indiana University School of Medicine, Indianapolis, IN 46202-5119, USA.
Insights
Postnatal growth failure affects most extremely low birth weight infants. Aggressive nutritional support in the neonatal intensive care unit and post-discharge improves growth outcomes for these vulnerable infants.
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.
Abstract:
Postnatal growth failure is extremely common in the very low birth weight and extremely low birth weight infant. Recent data from the National Institute of Child and Human Development (NICHD) Neonatal Research Network indicates that 16% of extremely low birth weight infants are small for gestational age at birth, but by 36 weeks corrected age, 89% have growth failure. Follow-up at 18 to 22 months corrected age shows that 40% still have weights, lengths, and head circumferences less than the 10th percentile. Growth failure is associated with an increased risk of poor neurodevelopmental outcome. Inadequate postnatal nutrition is an important factor contributing to growth failure, as most extremely low birth weight infants experience major protein and energy deficits during the neonatal intensive care unit hospitalization, in spite of the fact that nutrition sufficient to support intrauterine growth rates can generally be provided safely. Aggressive nutritional support--parenteral and enteral--is well tolerated in the extremely low birth weight infant and is effective in improving growth. Continued provision of appropriate nutrition (premature formula or fortified human milk) is important throughout the neonatal intensive care unit stay. After discharge, nutrient-enriched postdischarge formula should be continued for approximately 9 months post-term. Exclusively breast-fed infants require additional supplementation/fortification postdischarge as well. Additional trials are needed to address a number of important questions concerning the role of nutrition and growth on ultimate development.
