Author(s): E. Ziegler
Delivering adequate amounts of nutrients to premature
infants at all times is challenging because the infant’s immature
gastrointestinal tract is initially unable to accept feedings, necessitating
the use of parenteral nutrition. In the past, inadequate amounts of nutrients
have commonly been given to premature infants because the administration of
nutrients was thought to be hazardous. Inadequate nutrient intakes have resulted
in widespread postnatal growth restriction.
Now that it is known that postnatal growth restriction is
associated with poor neurocognitive development, efforts are made to increase
nutrient intakes. In this review, nutrient requirements of premature infants
that have been determined by the factorial and empirical methods are reviewed.
Current good practices regarding parenteral nutrition are
discussed, as are guidelines for the introduction and advancement of enteral
feedings. Because of its trophic effects on the gastrointestinal tract and its
anti-infectious effects, human milk is strongly preferred as the early feeding
of choice for premature infants. Human milk also protects infants against
necrotizing enterocolitis. Once full feeding is achieved, the challenge is to
provide nutrients in amounts that support the infant’s growth like that of the
fetus. In the case of the infant fed his/her mother’s milk or banked donor
milk, nutrient fortification is necessary and is generally practiced.
However, adequate intakes of protein are seldom achieved
with routine fortification and methods of providing additional fortification
are discussed.