Extrauterine growth restriction in preterm infants: importance of optimizing nutrition in neonatal intensive care...

Area of Science:

• Neonatal Intensive Care
• Pediatric Nutrition
• Developmental Pediatrics

Background:

• Extrauterine growth restriction in preterm infants is linked to suboptimal nutrition and has long-term adverse effects on growth and neurodevelopment.
• Parenteral feeding is essential initially, but early enteral feeding is vital for gut maturation and preventing complications like sepsis and cholestatic jaundice.
• Existing evidence from numerous trials provides a basis for feeding protocols, emphasizing mother's own preterm breast milk, supplemented or substituted with preterm formula.

Purpose of the Study:

• To review current evidence on nutritional management of preterm infants.
• To highlight the importance of early enteral feeding for gut health and development.
• To identify the need for large-scale, long-term trials evaluating aggressive nutritional strategies.

Main Methods:

• Review of over sixty randomized clinical trials and ten Cochrane Library systematic reviews.
• Analysis of feeding strategies, including parenteral and enteral routes.
• Focus on evidence supporting early trophic enteral feeding and optimal milk choices.

Main Results:

• Early enteral feeding, even in trophic amounts, promotes gut motility, bile secretion, and lactase activity while reducing sepsis and cholestatic jaundice.
• Preterm breast milk supplemented with human milk fortifier is recommended; preterm formula is a suitable alternative.
• Current reviews often lack focus on long-term clinical outcomes.

Conclusions:

• Suboptimal nutrition and extrauterine growth restriction pose significant risks for preterm infants.
• Early, aggressive nutritional management, including optimized enteral feeding, is critical for improving long-term outcomes.
• Further large-scale, long-term randomized controlled trials are urgently needed to refine nutritional protocols.