The scientific studies of the eighteenth and nineteenth centuries that underpinned
the development of more recent pediatric nutritional practice occurred long before
the formal development of pediatrics.
There has been long-standing interest in whether a stimulus at a sensitive or critical
period in development could have a long-lasting or permanent "programming" influence
on later structure or function.
The feeding of preterm infants is a substitute for the placental nutrient supply that provides
the substrates required for intrauterine growth and development.
The potential importance of the early nutritional management of low-birthweight
(LBW) infants, including the early use of parenteral amino acids, is best illustrated
by the pattern of their early growth.
Intravenous lipid (IL) emulsions are important constituents of total parenteral nutrition
(TPN) because they provide essential fatty acids and allow an increase in energy
intake without giving an excess of glucose, which may be associated with an increase
in carbon dioxide production.
Human milk may confer nutritional and nonnutritional advantages in feeding the
preterm infant, including protection against infections and enhanced intestinal development.
The American Academy of Pediatrics recommends breastfeeding throughout the first
year after birth for the full-term neonate and acknowledges the benefits of human milk
in the management of premature infants (1).
Oxygen represents one of the more fascinating biological paradoxes, for, while lifegiving
in normal concentrations, it becomes universally toxic to cells and organisms
at hyperoxic levels.
Iron, a transition metal, can take part in redox processes by undergoing reversible valency
changes. It plays an essential role in oxygen transport by hemoglobin in erythrocytes,
oxygen storage by myoglobin in muscle, and electron transfer and energy
metabolism in mitochondria.
The nutritional problems of preterm babies have become particularly relevant in the
last decade because of the increased survival of extremely low birthweight (ELBW)
infants and the numerous studies underlining the importance of early feeding on
short- and long-term development (1).
In most neonatal units, the number of extremely immature infants has increased considerably
over the last 15 years. Their mortality and morbidity have decreased, and
more attention has been paid to their nutritional needs.
Humans live in close association with vast numbers of microorganisms that are present
on the skin, in the mouth, and in the gastrointestinal tract.
Necrotizing enterocolitis (NEC) is an acquired syndrome affecting the gastrointestinal
tract defined as "ischemic-inflammatory necrosis of neonatal bowel." This syndrome
is one of the most serious problems affecting newborns, and its frequency is
greatest among premature and low-birthweight (LBW) infants (increased between
fourfold and 10-fold compared with full-term infants) (1).
Motor function is exerted by the three muscle layers that comprise the outer layers of
the intestine. These muscle layers must contract in a coordinated fashion
Nutrient requirements have been described for the extremely low-birthweight infant
(ELBW; less than 1,000 g birthweight) (1-3).
The question of when to start enteral feeding confronts the caretaker of very lowbirthweight
(VLBW) infants on a daily basis. Seemingly conflicting objectives enter
The gastrointestinal tract undergoes substantial changes during the period of development.
Profound growth, morphological changes, and functional maturation are observed
during this developmental period in the small intestine.