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Optimising enteral nutrition in growth restricted extremely preterm neonates--a difficult proposition

P Shah1, E Nathan2,3, D Doherty2,3

  • 1a Department of Neonatal Paediatrics , KEM Hospital for Women , Perth , Australia .

The Journal of Maternal-Fetal & Neonatal Medicine : the Official Journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians
|October 11, 2014
PubMed

Insights

Optimizing nutrition for extremely preterm neonates with intrauterine growth restriction is challenging. These infants experienced delayed feeding initiation and slower advancement to full feeds, with higher rates of postnatal growth restriction.

Area of Science:

  • Neonatalogy
  • Pediatric Nutrition
  • Perinatology

Background:

  • Extremely preterm (EP) neonates (<28 weeks gestation) with intrauterine growth restriction (IUGR) face significant challenges in enteral nutrition.
  • Higher risks of necrotizing enterocolitis (NEC) and feed intolerance complicate nutritional management in this vulnerable population.

Purpose of the Study:

  • To evaluate the nutritional outcomes in extremely preterm neonates diagnosed with intrauterine growth restriction.
  • Assess the impact of IUGR on feeding progression and growth in EP infants.

Main Methods:

  • Retrospective data collection from medical records of EP neonates surviving the first 72 hours (January 2009-December 2010).
  • Analysis included demographic data, feeding protocols (milk type, initiation age), and outcomes until discharge or death.
  • A standardized feeding protocol was applied throughout the study period.

Main Results:

  • Neonates with IUGR (17.3%) showed significantly delayed initiation of minimal enteral nutrition and nutritional feeds compared to non-IUGR infants.
  • IUGR neonates reached full enteral feeds (150 ml/kg/day) at a later postnatal age and required more time to achieve this milestone.
  • Postnatal growth restriction was significantly more prevalent in the IUGR group (73% vs. 45%).

Conclusions:

  • Current enteral nutrition strategies are insufficient for optimizing nutritional outcomes in growth-restricted extremely preterm neonates.
  • The findings highlight the difficulties in feeding management and the increased risk of growth failure in this specific cohort.
Abstract

Keywords:
Feedinggrowth restrictionintrauterinenecrotising enterocolitisneonatespreterm

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