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Optimizing nutrition in preterm infants
1Department of Neonatology, China Medical University Children's Hospital, Taichung, Taiwan; School of Medicine, China Medical University, Taichung, Taiwan.
Insights
Extrauterine growth restriction affects many very preterm infants, increasing neurodevelopmental risks. Early, aggressive nutrition, including protein and energy, improves growth and is crucial for better outcomes.
Area of Science:
- Neonatalogy
- Pediatric Nutrition
- Developmental Pediatrics
Background:
- Extrauterine growth restriction (EUGR) is prevalent in very preterm infants, with incidence varying widely (43-97%).
- EUGR is linked to adverse neurodevelopmental outcomes.
- Inadequate postnatal nutrition, characterized by protein and energy deficits in the neonatal intensive care unit (NICU), contributes significantly to growth failure.
Purpose of the Study:
- To review the impact of nutrition on extrauterine growth restriction in very preterm infants.
- To highlight the association between early nutrition and long-term developmental outcomes.
- To discuss current nutritional strategies and areas for future research.
Main Methods:
- Review of existing literature on neonatal nutrition and growth outcomes in preterm infants.
- Analysis of the relationship between protein and energy intake and neurodevelopmental results.
- Examination of different nutritional approaches, including parenteral, enteral, and post-discharge feeding.
Main Results:
- First-week protein and energy intake correlate with 18-month developmental outcomes.
- Early aggressive nutritional support (parenteral and enteral) is well-tolerated and promotes growth.
- Optimizing protein-to-energy ratios may enhance lean mass accretion.
Conclusions:
- Optimizing nutritional strategies is essential for improving growth and neurodevelopmental outcomes in very preterm infants.
- Continued appropriate nutrition, including fortified human milk or specialized formulas, is vital during hospitalization and after discharge.
- Further research is needed to refine nutritional requirements and assess long-term effects.
Abstract:
Extrauterine growth restriction is common in very preterm infants. The incidence in very-low-birth-weight infants ranges between 43% and 97% in various centers, with a wide variability due to the use of different reference growth charts and nonstandard nutritional strategies. Extrauterine growth restriction is associated with an increased risk of poor neurodevelopmental outcome. Inadequate postnatal nutrition is an important factor contributing to growth failure, as most very preterm infants experience major protein and energy deficits during neonatal intensive care unit hospitalization. First-week protein and energy intake are associated with 18-month developmental outcomes in very preterm infants. Early aggressive nutrition, including parenteral and enteral, is well tolerated in the very preterm infant and is effective in improving growth. Continued provision of appropriate nutrition (fortified human milk or premature formula) is important throughout the growing care during the hospitalization. After discharge, exclusively breast-fed infants require additional supplementation. If formula-fed, nutrient-enriched postdischarge formula should be continued for approximately 9 months corrected age. Supplementation of the preterm formulas with protein would increase the protein/energy ratio (3 g/100 kcal), leading to increased lean mass with relatively decreased fat deposition. Further research is required to optimize the nutritional needs of preterm infants and to evaluate the effects of nutritional interventions on long-term growth, neurodevelopment, and other health outcomes.
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