Nutrition Publication

Nutrition of the Low-Birth-Weight Infant

Editor(s): F. Haschke. 69 / 1

Preterm birth has to be acknowledged as a nutritional emergency. When nutrition is adequate severe short and long-term consequences can be prevented. However, in practice adequate nutrient provision is rarely achieved. Proper and frequent monitoring as well as further research is required to increase our understanding of the nutrtitional requirements in this vulnerable population. The nutritional challenges do not end when the preterm infant leaves the hospital. This issue of the Annales indicates ways to achieve adequate nutrition of the LBW and VLBW infant during hospital stay and after discharge. Finally the clinical evidence of some common types of supplements are thoroughly reviewed.

Related Articles

Meeting the Nutritional Needs of the Low-Birth-Weight Infant

Author(s): E. Ziegler

Delivering adequate amounts of nutrients to prematureinfants at all times is challenging because the infant’s immaturegastrointestinal tract is initially unable to accept feedings, necessitatingthe use of parenteral nutrition. In the past, inadequate amounts of nutrientshave commonly been given to premature infants because the administration ofnutrients was thought to be hazardous. Inadequate nutrient intakes have resultedin widespread postnatal growth restriction.Now that it is known that postnatal growth restriction isassociated with poor neurocognitive development, efforts are made to increasenutrient intakes. In this review, nutrient requirements of premature infantsthat have been determined by the factorial and empirical methods are reviewed.Current good practices regarding parenteral nutrition arediscussed, as are guidelines for the introduction and advancement of enteralfeedings. Because of its trophic effects on the gastrointestinal tract and itsanti-infectious effects, human milk is strongly preferred as the early feedingof choice for premature infants. Human milk also protects infants againstnecrotizing enterocolitis. Once full feeding is achieved, the challenge is toprovide nutrients in amounts that support the infant’s growth like that of thefetus. In the case of the infant fed his/her mother’s milk or banked donormilk, nutrient fortification is necessary and is generally practiced.However, adequate intakes of protein are seldom achievedwith routine fortification and methods of providing additional fortificationare discussed.

Feeding Very-Low-Birth-Weight Infants: Our Aspirations versus the Reality in Practice

Author(s): W. Corpeleijn, M. Vermeulen, C. van den Akker, J. van Goudoever

Recently, new guidelines for enteral feedings in prematureinfants were issued by the European Society of Pediatric Gastroenterology,Hepatology, and Nutrition Committee on Nutrition. Nevertheless, practice provesdifficult to attain suggested intakes at all times, and occurrence ofsignificant potential cumulative nutritional deficits ‘lies in wait’ in theneonatal intensive care unit. This review describes several aspects that aremandatory for optimizing nutritional intake in these vulnerable infants. Theseaspects range from optimal infrastructure to the initiation of parenteralnutrition with proper transition to enteral breast or formula feedings. Propermonitoring of nutritional tolerance includes serum biochemistry although properspecific markers are unknown and safety reference values are lacking. Althougha lot of progress has been made through research during the last few decades,numerous questions still remain unanswered as to what would be the optimalquantity and quality of the various macronutrients. The inevitable suboptimalintake may, however, contribute significantly to the incidence of neonataldiseases, including impaired neurodevelopment. Therefore, it is pivotal thatall hospital staff acknowledges that preterm birth is a nutritional emergencyand that all must be done, both in clinical practice as well as in research, toreduce nutritional deficits.

Nutrition of Preterm Infants after Discharge

Author(s): R. Cooke

The fundamental principle underlying nutritional support is thatintake meets needs thereby ensuring the best outcome, which, in the case of thepreterm infant, is optimal growth and development. Achieving this goal isproblematic. Most, if not all, very-low-birth-weight infants (VLBWI) areundernourished and under-grown when they are first discharged from thehospital. This has important implications for the nutritional care of preterm,particularly the breast-fed, VLBWI after hospital discharge.

Is Early Nutrition Related to Short-Term Health and Long-Term Outcome?

Author(s): H. Szajewska, M. Makrides

This paper summarizes the literature concerning the effects ofadministering (1) long-chain polyunsaturated fatty acids (LCPUFA), (2)probiotics and/or (3) prebiotics to preterm infants. Clinically relevant,short- and long-term efficacy outcomes, such as those related to a reduced riskof disease, as well as outcomes related to safety, were sought. MEDLINE and theCochrane Library literature searches performed in September 2010 were limitedto randomized controlled trials, their systematic reviews or meta-analyses.LCPUFA supplementation, particularly docosahexaenoic acid (DHA), of infantformula for preterm infants has consistently demonstrated better visualdevelopment of preterm infants compared with unsupplemented formulas. There isincreasing evidence to suggest that LCPUFA supplementation for preterm infantsis also related to improvements in more global measures of development, withoutany adverse effects. It is, however, important to note that the DHA dosestested in the infant formula interventions for preterm infants have been ratherconservative. Newer studies comparing dietary DHA concentrations that match inutero accumulation rates with dietary DHA concentrations typical in the milk ofwomen consuming little fish or in supplemented infant formulas demonstrate thatthese higher DHA doses are related to improvements in domains of cognitivedevelopment. Although further work is needed to better understand the optimal DHArequirements of preterm infants, it is clear that a dietary source of DHA isimportant to support neurodevelopment. To date, the most promising applicationof probiotics in preterm infants is the prevention of necrotizing enterocolitisby the administration of certain probiotics. Many other benefits ofadministering probiotics and/or prebiotics to preterm infants are, however,largely unproven. Efficacy and safety should be established for each probioticand/or  prebiotic product. Furtherresearch should specify strain-specific outcomes and determine optimal dosingschedules. Safety and long-term follow-up studies are of particular interest.