Dr. Umesh Vaidya - Consultant and Head in Neonatology KEM Hospital (Pune) This video touches upon the goal of nutrition and how much nutritional intake is required by infants. Citing examples of certain intensive care babies the talk highlights the impact and considerations required for treating undernourished infants while laying emphasis on the consequences of inadequate early nutrition. While the talk highlights of achieving optimal growth as a concept, it also talks of milk fortification. At length, the talk covers the possibility of the prevention of NEC and the co-relation with probiotics. Dr. Umesh also touches upon the changes in parental nutrition with the aim of focusing on monitoring pre-term and LBWs for growth and metabolism.
Most VLBWs have slow growth and suffer nutritional deprivation. Continuation of strategies not supported by evidence based medicine. There is a wide diversity of practices in nutrition which leads to uncertainties. Barker theory states that foetal malnutrition, low weight gain in infancy and excess weight in early childhood leads to chronic diseases in adulthood, CAD, HTN and type2 diabetes.
The recent concepts say that lipids can be started within 24 hours of birth, starting dose: 1 g /kg/day (prevents EFA deficiency), use 10% emulsions (till 2 g 1kg / day), glucose tolerance gets better and it should comprise 30-50% of non-protein calories. Metabolic syndrome is the clustering of obesity, aberrant glucose metabolism, dyslipidemia and hypertension and associates with increased risk of later cardiovascular disease and diabetes. The incidence at 16 years is 2.4%. Prospective cohort study shows relationship between catch up growth and obesity. Three systematic reviews described consistent association between rapid infancy growth and subsequent obesity risk in childhood and later life. Coronary heart disease is also associated with preterm babies since small size at birth followed by accelerated growth in childhood is associated with increased risk of death from coronary heart disease. Accelerated neonatal growth increases the later propensity to cardiovascular disease whereas slower growth is beneficial. Over nutrition and rapid growth in infancy in associated with enhanced risk of obesity, diabetes, hypertension and cardiovascular disease
In preterm babies it is difficult to match in utero growth, but essential to prevent clinical malnutrition in NICU. Early feeding and grading up is required with fortification and parenteral nutrition. NEC can be prevented to some extent by antenatal steroids, proper feeding policy, enteral antibiotics and probiotics. Osteopenia raises many unresolved questions and proper supplementation of calcium and phosphate with passive exercises is required. Parenteral Nutrition plays a certain role in VLBW survival since an early use and moderate dosing is advised. Catch up growth requires an aim for adequate rather than fast catch up while monitoring preterm and LBWs for growth and metabolism.