Related Experiment Video
Updated: Oct 2, 2025
Transcutaneous Microcirculatory Imaging in Preterm Neonates
Published on: December 31, 2015
Optimising growth in very preterm infants: reviewing the evidence
Aneurin Young1,2, R Mark Beattie3, Mark John Johnson4,2
1Department of Neonatal Medicine, University Hospital Southampton NHS Foundation Trust, Southampton, UK a.young@soton.ac.uk.
Insights
Optimizing growth for very preterm infants is complex. Current research explores growth patterns that enhance neurodevelopment while considering long-term metabolic health, challenging traditional fetal growth targets.
Area of Science:
- Neonatalogy
- Pediatric Nutrition
- Developmental Pediatrics
Background:
- Infants born before 32 weeks' postmenstrual age face high risks of growth failure.
- Traditional guidelines recommend matching fetal growth, but this is challenged by prematurity complications.
- Emerging research questions fetal growth targets, focusing instead on optimizing long-term outcomes.
Purpose of the Study:
- To review competing definitions of optimal growth for very preterm infants.
- To examine advances in determining nutritional requirements (macronutrients and micronutrients).
- To identify barriers to achieving optimal nutrition and growth in this population.
Main Methods:
- Narrative review of recent scientific evidence.
- Examination of research on neurodevelopmental and metabolic outcomes.
- Analysis of nutritional intake targets and clinical practice implications.
Main Results:
- Conflicting evidence exists regarding the optimal growth trajectory for preterm infants.
- Neurodevelopmental benefits of enhanced neonatal growth are noted, but potential risks for metabolic syndrome exist.
- Determining precise nutritional needs remains challenging due to individual variations and barriers.
Conclusions:
- Defining optimal growth for very preterm infants is complex and debated.
- Individualized nutritional strategies and multidisciplinary management are crucial.
- Further research is needed to establish definitive nutritional targets for improved long-term outcomes.
Abstract:
Infants born before 32 weeks' postmenstrual age are at a high risk of growth failure. International guidelines have long recommended that they match the growth of an equivalent fetus, despite the challenges posed by ex utero life and comorbidities of prematurity. Several groups have recently questioned the necessity or desirability of this target, shifting attention to aiming for growth which optimises important long-term outcomes. Specifically, recent research has identified the neurodevelopmental benefits of enhanced growth during the neonatal period, but work in term infant suggests that rapid growth may promote the metabolic syndrome in later life. In this context, defining a pattern of growth which optimises outcomes is complex, controversial and contested. Even if an optimal pattern of growth can be defined, determining the nutritional requirements to achieve such growth is not straightforward, and investigations into the nutritional needs of the very preterm infant continue. Furthermore, each infant has individual nutritional needs and may encounter a number of barriers to achieving good nutrition. This article offers a narrative review of recent evidence for the competing definitions of optimal growth in this cohort. It examines recent advances in the determination of macronutrient and micronutrient intake targets along with common barriers to achieving good nutrition and growth. Finally, key implications for clinical practice are set out and a recommendation for structured multidisciplinary management of nutrition and growth is illustrated.
