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Early postnatal nutritional requirements of the very preterm infant based on a presentation at the NICHD-AAP workshop
1Neonatal Clinical Research Center and the UCHSC Perinatal Research Center, University of Colorado Health Sciences Center, Aurora, 80045, USA. bill.hay@uchsc.edu
Insights
Fetal nutrition guides infant care. Very preterm infants receive imbalanced nutrients post-birth, leading to poor growth and long-term health issues, highlighting the need for optimized infant nutrition strategies.
Area of Science:
- Neonatal nutrition
- Fetal development
- Pediatric growth
Background:
- Fetal nutrition is crucial for understanding infant needs, particularly for very preterm infants.
- Fetal nutrient uptake (lipids, glucose, amino acids) changes significantly with gestational age.
- Essential fatty acids are vital for central nervous system development in fetuses.
Purpose of the Study:
- To compare fetal nutrient utilization with postnatal nutritional practices in very preterm infants.
- To investigate the impact of current feeding strategies on the growth and development of preterm infants.
- To identify optimal nutritional strategies for improving outcomes in very preterm infants.
Main Methods:
- Comparative analysis of fetal nutrient uptake data with typical postnatal feeding regimens for very preterm infants.
- Review of existing literature on fetal and neonatal metabolism and growth.
- Examination of the consequences of postnatal growth restriction in preterm infants.
Main Results:
- Fetal nutrient requirements differ significantly from the typical postnatal intake of very preterm infants, with higher amino acid needs in utero.
- Postnatal feeding often overemphasizes lipids and glucose while underproviding amino acids and protein for very preterm infants.
- This nutritional imbalance leads to fat accumulation and growth restriction in preterm infants by term-equivalent age.
Conclusions:
- Current postnatal nutrition for very preterm infants does not match fetal requirements, contributing to adverse outcomes.
- Optimizing nutritional strategies based on fetal growth patterns is essential for improving preterm infant health.
- Further research into fetal and neonatal metabolic needs is required to refine feeding protocols and enhance long-term infant development.
Abstract:
Normal fetal nutrition is a useful guide for understanding postnatal nutrition of infants born very preterm. Fetal lipid uptake gradually increases towards term and is primarily used to produce fat in adipose tissue, with essential fatty acid uptake providing necessary structural and functional elements in membranes of cells in the central nervous system. Fetal glucose uptake and utilization rates are nearly twice as high at 23-26 weeks gestation as they are at term, contributing primarily to energy production and glycogen formation. Amino-acid uptake by the fetus is two-to threefold greater at 23-26 weeks gestation than at term and is required to meet the very high fractional protein synthesis and growth rates at this gestational period; amino acids also contribute significantly to fetal energy production. In contrast, after birth most of the very preterm infants are fed more lipid and glucose and less amino acids and protein than they need. Not surprisingly, therefore, very preterm infants accumulate fat but remain relatively growth restricted at term gestational age compared to those infants who grew normally in utero, and this postnatal growth restriction has long-term adverse growth, development, and health consequences. More thorough understanding of the unique nutritional, metabolic, and growth requirements of the normally growing fetus and the very preterm infant, once born, are needed to determine optimal nutritional strategies to improve the outcome of preterm infants.
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