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Survey: methods of feeding low-birth-weight infants
Insights
Neonatal intensive care units tailor feeding for low-birth-weight infants based on weight. Practices vary, with some infants receiving parenteral nutrition longer and initial enteral feedings using sterile water or milk, supplemented with nutrients.
Area of Science:
- Neonatalogy
- Pediatric Nutrition
- Infant Feeding Practices
Background:
- Low-birth-weight infants require specialized nutritional support in neonatal intensive care units (NICUs).
- Established feeding protocols are crucial for optimizing growth and development in vulnerable neonates.
Purpose of the Study:
- To survey NICU directors regarding current feeding practices for low-birth-weight infants.
- To identify variations in nutritional support based on infant characteristics and unit protocols.
Main Methods:
- A survey was distributed to directors of 269 NICUs.
- Data collected focused on feeding routes, initial feeding composition, and supplementation strategies.
Main Results:
- Feeding practices are stratified by infant birth weight, with smaller infants receiving parenteral nutrition longer.
- Nasogastric feeding is common for infants ≤1,500g, while transpyloric routes are used for <1,000g infants in some NICUs.
- Initial enteral feeds varied (sterile water, glucose water, milk), and human milk or formula were used post-establishment, often supplemented with energy and vitamins, but not consistently with calcium and phosphorus.
Conclusions:
- NICU feeding protocols for low-birth-weight infants are diverse and weight-dependent.
- Potential for vitamin over- or under-supplementation exists, highlighting the need for standardized guidelines.
- Further research is needed to clarify the optimal use of human milk versus formula and specific supplementation regimens.
Abstract:
The directors of 269 neonatal intensive care units were surveyed to determine how low-birth-weight infants are being fed. Feeding practices were based on birth weight, with the smallest infants receiving parenteral nutrition for the longest time after birth. First enteral feedings usually were given by the nasogastric route in infants with birth weight of 1,500 g or less, but transpyloric feedings were used in 15% of neonatal intensive care units for infants with birth weight less than 1,000 g. The initial enteral feeding was sterile water in 56% to 58% of the neonatal intensive care units, but was glucose water or milk in the others. Once enteral feeding was established, both human milk from the infant's own mother and commercial formula were used. Whether human milk was mixed or alternated with infant formula, or whether some infants in the nursery were fed human milk while others were fed formula, was not determined. The type of infant formula fed to low-birth-weight infants depended on the infant's birth weight and clinical status. Both human milk and formula were supplemented with energy (fat or carbohydrates) and vitamins, but not with calcium and phosphorus, in most neonatal intensive care units. Some vitamins, such as vitamins A and D, may be oversupplemented, while others, such as folic acid, may be undersupplemented.