Classification and Special Nutritional Needs of SGA Infants and Neonates of Multiple Pregnancies

Area of Science:

• Neonatology
• Pediatric Nutrition
• Perinatal Medicine

Background:

• Limited data exist on nutritional management for preterm small for gestational age (SGA) infants.
• ESPGHAN guidelines increased energy recommendations for very preterm infants, but individual needs vary.
• Distinguishing fetal growth-restricted (FGR) from constitutional SGA, and preterm SGA from preterm appropriate for gestational age (AGA) is crucial due to differing nutritional requirements.

Purpose of the Study:

• To review current knowledge on the nutritional needs of preterm infants with fetal growth restriction (FGR).
• To address the specific nutritional requirements of FGR infants born from multiple gestations.
• To inform optimal nutritional strategies for vulnerable preterm populations.

Main Methods:

• Literature review of existing studies and guidelines on preterm infant nutrition.
• Analysis of nutritional deficits in preterm FGR infants based on prematurity, intrauterine malnutrition, and morbidities.
• Examination of the impact of multiple gestations on FGR and associated nutritional considerations.

Main Results:

• Preterm FGR infants, especially those born before 29 weeks' gestation, accumulate significant nutrient deficits.
• Aggressive nutritional support is often necessary for optimal catch-up growth and neurodevelopment in preterm FGR infants.
• Excessive postnatal catch-up growth in FGR infants may lead to later adverse metabolic consequences.

Conclusions:

• Preterm FGR infants require tailored, aggressive nutritional management to mitigate intrauterine deficits.
• Careful balancing of nutrition is essential to promote growth without inducing adverse metabolic outcomes.
• Further research is needed on the unique nutritional challenges of FGR in multiple gestations.