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Nutritional strategies for the very low birthweight infant
\"The goal of nutritional management in VLBW and ELBW infants is the achievement of postnatal growth at a rate that approximates the intrauterine growth of a normal fetus at the same postconceptional age. In reality, however, growth lags considerably after birth; although non-nutritional factors are involved, nutrient deficiencies are critical in explaining delayed growth. This practical clinically-oriented pocketbook reviews and summarises all available clinical evidence. It enables the reader to implement parenteral or enteral feeding plans, with the goals of reducing postnatal weight loss, earlier return to birthweight, and improved catch-up growth. Both nutrient balance and growth and the impact on neurodevelopment and health outcomes are evaluated. With many tables and algorithms to summarise key data and management strategies, Nutritional Strategies for the Very Low Birthweight Infant is an invaluable guide for all healthcare professionals caring for premature babies\"--Provided by publisher.
Book
Use of human milk and fortification in the NICU
Human milk is the gold standard to provide nutritional support for all healthy and sick newborn infants including the very low birth weight (VLBW) infant (<1500 g). It has both nutritional and anti-infective properties which are especially important for these infants at risk for sepsis and necrotizing enterocolitis. Human milk alone is insufficient to meet the nutritional needs for VLBW infants, especially protein and minerals. There is a conundrum between achieving the nutritional, immunologic, developmental, psychological, social, and economic benefit with human milk vs. the inadequate growth with unfortified human milk for VLBW leading to nutritional inadequacy, growth failure and poor neurodevelopmental outcome. The use of multicomponent fortifiers to increase calories and provide additional protein, vitamins, and minerals has been associated with short-term benefits in growth. Most current fortifiers are derived from cow’s milk, however there are concerns regarding a possible association between the use of cow’s milk-based fortifier and NEC. There is also an exclusive human milk diet with a fortifier derived solely from human milk. There are three approaches for fortifying human milk and include fixed dosage or “blind fortification”, adjustable fortification using the blood urea nitrogen as a surrogate for protein nutriture to modify dosage of fortification, and targeted, individualized fortification that is based on periodic human milk analysis.
Journal Article
COMMENTARY: Searching for biomarkers and regulators of growth in very preterm infants with new fortifiers
In this issue of Pediatric Research Holgerson et al. report measurements of plasma glucose-regulatory hormones in 225 very preterm infants (VPIs) showing that these hormone levels were minimally affected by a novel bovine colostrum fortifier and did not seem to be appropriate biomarkers of early postnatal growth for individual VPIs.
Journal Article
Nutritional Strategies for the Very Low Birthweight Infant
The goal of nutritional management in VLBW and ELBW infants is the achievement of postnatal growth at a rate that approximates the intrauterine growth of a normal fetus at the same postconceptional age. In reality, however, growth lags considerably after birth; although non-nutritional factors are involved, nutrient deficiencies are critical in explaining delayed growth. This practical clinically-oriented pocketbook reviews and summarises all available clinical evidence. It enables the reader to implement parenteral or enteral feeding plans, with the goals of reducing postnatal weight loss, earlier return to birthweight, and improved catch-up growth. Both nutrient balance and growth and the impact on neurodevelopment and health outcomes are evaluated. With many tables and algorithms to summarise key data and management strategies, Nutritional Strategies for the Very Low Birthweight Infant is an invaluable guide for all healthcare professionals caring for premature babies.
eBook
Pragmatic Approach to In-Hospital Nutrition in High-Risk Neonates
Extremely low birth weight infants may experience periods of moderate to severe undernutrition during the acute phase of their respiratory problems. This undernutrition contributes to early growth deficits in these patients and may have long-lasting effects, including poor neurodevelopmental outcome. Early postnatal intravenous amino-acid administration and early enteral feeding strategies will minimize the interruption of nutrient intake that occurs with premature birth. These two strategies will prevent intracellular energy failure, allow the administration of more non-protein energy, as well as enhance overall nutritional health, as evidenced by less postnatal weight loss and earlier return to birth weight, and improved overall postnatal growth and outcome.
Journal Article
Prediction of Extrauterine Growth Retardation (EUGR) in VVLBW Infants
BACKGROUND:
Long-term growth failure in very very low birth weight (VVLBW) infants is a common complication of extreme prematurity. Critical illnesses create challenges to adequate nutriture.
PURPOSE:
To identify predictors of extrauterine growth retardation (EUGR) in VVLBW infants and to evaluate their nutritional intake and subsequent growth.
STUDY DESIGN:
A 4-year retrospective chart review of 221 infants ≤1000 g birth weight and ≤29 weeks gestational age who were admitted within 24 hours of birth, were free of major congenital anomalies and survived at least 7 days. Daily intakes and anthropomorphic data were collected and analyzed. Significant events during hospitalization were documented.
RESULTS:
Mean energy and protein intakes during hospitalization did not reach recommendations of 120 kcal/kg/d and 3.0 g/kg/day.
In utero
growth rates could not be consistently reached or sustained. As expected, BW (as measured by BW percentile score) was highly predictive of EUGR (
p
<0.001). When the independent effect of other predictors of EUGR was considered, only days of total parenteral nutrition (
p
<0.001) and HC percentile at return to birth weight (
p
<0.001) made a significant contribution to the prediction of EUGR, once the effect of BW was taken into account.
Journal Article
Postnatal Malnutrition of Extremely Low Birth-Weight Infants With Catch-Up Growth Postdischarge
Objective:
To assess nutritional intakes and subsequent growth of extremely low birth-weight (BW) infants.
Study Design:
Chart review of 69 extremely low BW infants stratified into two groups by BW: ≤750 g (group 1;
n
=27) or 751 to 1000 g (group 2;
n
=42). Dietary intakes, weights, and head circumferences (HC) were collected through discharge and at 1 month postdischarge. The differences between goals and intakes were calculated weekly during hospitalization. Descriptive comparisons were made between growth parameters at birth, discharge, and follow-up.
Results:
Total energy and protein deficits were inversely related to BW. Both groups exhibited extrauterine growth retardation while hospitalized. After discharge, the rates of weight gain and HC growth increased, leading to some growth recovery at follow-up.
Conclusions:
Existing feeding methods resulted in sizeable deficits in energy and protein, particularly for the smallest infants. Changing current practices to limit these deficits is essential to improving postnatal growth.
Journal Article
Intravenous carbohydrates
The glucose infusion rate should maintain euglycemia. Glucose intolerance, defined as inability to maintain euglycemia at glucose administration rates < 6 mg/kg/min, is a frequent problem in VLBW infants, and especially in ELBW infants. The plasma glucose concentration should be kept below 130 mg/dL. This hyperglycemia in ELBW infants may also occur in combination with nonoliguric hyperkalemia. As discussed later (Chapter 6), these co-morbidities may be prevented with the early use of TPN.Endogenous glucose production is elevated in VLBW infants compared with term infants and adults. High glucose production rates are found in VLBW infants who received only glucose compared to those receiving glucose plus amino acids and/or lipids. Clinical experience with hyperglycemia suggests that administration of glucose alone does not always suppress glucose production in VLBW infants. It appears that persistent glucose production is the main cause of hyperglycemia and is fueled by ongoing proteolysis that is not suppressed by physiologic concentrations of insulin. In addition, abnormally low peripheral glucose utilization may also contribute to hyperglycemia. Therefore a 5% glucose concentration instead of the standard 10% concentration of glucose may have to be used in more immature ELBW infants (<750 g).Glucose intolerance can limit delivery of energy to the infant to a fraction of the resting energy expenditure, resulting in negative energy balance. Several strategies are used to manage this early hyperglycemia in ELBW infants as well as to increase energy intake.Decreasing glucose administration until hyperglycemia resolves (unless the hyperglycemia is so severe that this strategy would require infusion of a hypotonic solution).[…]
Book Chapter
Parenteral nutrition guide
Early TPN should promote the overall nutritional health of the VLBW infant as evidenced by enhanced neurodevelopmental outcomes and growth at 18–22 months. In addition, males receiving early aggressive TPN showed improved head circumference growth at 18 months of age.Early TPN affects growth by decreasing the magnitude of the nadir of postnatal weight loss and supporting an earlier return to birthweight. This early growth advantage contributes to less postnatal growth failure and extrauterine growth restriction.Table 10.1 is the overall guide to providing TPN to VLBW infants. It is followed by Table 10.2, which assesses safety and tolerance to TPN with appropriate laboratory tests. Table 10.3 details the weaning TPN process as enteral nutrition is initiated and advanced, enabling the balance of fat, carbohydrates and protein.
Book Chapter