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