Nutrition beyond the neonatal intensive care unit: Best practices and optimal outcome measures

Despite advancements in nutritional management during the neonatal intensive care unit hospitalization, preterm infants remain smaller than term-born counterparts at the time of hospital discharge. The goal for nutritional management after discharge from the neonatal intensive care unit is to address ongoing nutrient and growth catch-up requirements and support growth and neurodevelopment while balancing the potential risks of too much growth. The current standard of care approach to post-hospitalization nutrition includes an individualized approach to nutritional supplementation with human milk fortification and/or nutrient enriched formulas, and incorporation of parental feeding choice and support of breastfeeding if desired into clinical decisions. Key gaps in the current literature include a need for evidence-based lactation and feeding support methods, and studies on a broad range of neonatal intensive care unit graduates, including those across the spectrum of prematurity and infants with other complex medical needs. Future research should aim for consistency in definitions of nutritional exposures and growth and developmental outcomes, involve parents in study design and choice of outcomes, and consider study design strategies which optimize longitudinal attrition rates. Addressing these gaps will provide clearer insights into the optimal nutritional strategy to improve long-term health outcomes for infants at the highest risk.