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Early, aggressive nutritional management for very low birth weight infants: what is the evidence?
1Department of Pediatrics and Obstetrics and Gynecology, Yale University School of Medicine, New Haven, CT 06520-8064, USA. richard.ehrenkranz@yale.edu
Insights
Extremely low gestational age neonates often experience growth failure. Early parenteral and enteral nutrition initiation is recommended to improve neonatal growth outcomes.
Area of Science:
- Neonatology
- Pediatric Nutrition
- Growth and Development
Background:
- Postnatal growth failure is common in extremely low gestational age neonates, with many falling below the 10th percentile by discharge.
- Nutritional practices vary significantly across newborn intensive care units, impacting observed infant growth.
- The American Academy of Pediatrics Committee on Nutrition aims for nutrient intakes mirroring fetal growth, a goal rarely achieved in this population.
Purpose of the Study:
- To review current evidence supporting early nutritional interventions for extremely low gestational age neonates.
- To highlight the importance of optimizing nutrient delivery to prevent postnatal growth restriction.
- To identify barriers to implementing recommended nutritional practices in neonatal intensive care.
Main Methods:
- Review of existing literature on neonatal nutrition and growth.
- Analysis of recommendations for early parenteral and enteral nutrition initiation.
- Discussion of variations in nutritional practices and their impact on growth.
Main Results:
- Evidence supports early initiation of parenteral nutrition, including amino acids (3 g/kg/d) within hours of birth and lipids (0.5–1.0 g/kg/d) within 24–30 hours.
- Early initiation of minimal enteral feedings within the first 5 days of life is also supported.
- Significant variations in nutritional practices exist, contributing to differing growth outcomes.
Conclusions:
- Optimizing early nutrition is crucial for improving growth in extremely low gestational age neonates.
- Neonatal clinicians must recognize and address barriers to implementing recommended early nutrition protocols.
- Consistent application of evidence-based nutritional practices can help mitigate postnatal growth failure.
Abstract:
The American Academy of Pediatrics Committee on Nutrition goal of providing 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 postmenstrual age is rarely met by extremely low gestational age neonates. Therefore, postnatal growth failure or growth restriction continues to be a problem experienced by many of these infants, and they are often less than the 10th percentile of reference intrauterine curves at the time of hospital discharge. Variation in nutritional practices, especially those practices concerned with the initiation and advancement of parenteral and enteral nutrition, largely explain the difference in growth observed at different newborn intensive care units. Although limited, the evidence supports recommendations to administer early parenteral and enteral nutrition, specifically initiation of an amino acid infusion providing about 3 g protein/kg/d within hours of birth, initiation of a lipid emulsion of 0.5 to 1.0 g lipids/kg/d within 24 to 30 hours of birth, and the initiation of minimal enteral feedings within the first 5 days of life. It is important that neonatal clinicians recognize the barriers and obstacles to the implementation of these recommendations.
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