Early Aggressive Nutrition for the Premature Infant

Background: Parenteral nutrition (PN) improves the growth and outcome of very low birth weight (VLBW) infants. Optimal PN composition, standard (STD-PN) or individualized (IND-PN), is still controversial. Aim: To compare IND-PN and STD-PN as to nutritional and growth parameters, complications and cost. Patients and Methods: 140 VLBW infants were studied. Each of the 70 neonates from the IND-PN group was matched with a neonate of similar gestational age (GA; ±4 days) on STD-PN. Data collection included demographic, maternal, intrapartum, neonatal, interventional, growth and nutritional data. Results: Compared to STD-PN infants, IND-PN infants had a significantly lower mean birth weight, greater need for resuscitation at birth and interventions thereafter. Nevertheless, IND-PN infants showed significantly greater weight gain SDS during the 1st week (p = 0.036) and the 1st month of life (p = 0.0004), and higher discharge weight SDS (p = 0.012) and head circumference SDS (p = 0.006). IND-PN infants received higher mean daily caloric intakes. They also had significantly shorter durations of exclusive PN and needed less electrolyte corrections. Conclusions: Compared to STD-PN infants, IND-PN infants achieved significantly better growth without added clinical or laboratory complications, had a shorter period of exclusive PN and less electrolyte corrections. IND-PN, in accordance with the current more aggressive nutritional approach, appears optimal for PN of VLBW infants. Yet, STD-PN with adequate composition is an appropriate alternative.

Section: Discussionsupporting

confidence: 81%

Standardized versus Individualized Parenteral Nutrition in Very Low Birth Weight Infants: A Comparative Study

Smolkin¹,

Diab²,

Shohat³

et al. 2010

“…Early randomised trials showed that parenteral nutrition improved survival by 40% in babies of 28-30 weeks' gestation with RDS and it is associated with a shorter hospital stay [120,121] . Full nutrition requirements for glucose, amino acids and lipids can be safely commenced on the first day of life and progressively increased to 3.5 g/kg/day of amino acids and 2.5-3.0 g/ kg/day lipids [122][123][124][125][126] . To maintain normoglycaemia and promote optimal growth, carbohydrate in the form of glucose should be given in the range of 6-18 g/kg/day.…”

Section: Fluid and Nutritional Managementmentioning

confidence: 99%

European Consensus Guidelines on the Management of Neonatal Respiratory Distress Syndrome in Preterm Infants – 2010 Update

Sweet

Carnielli²,

Greisen³

et al. 2010

233

175

These updated guidelines contain new evidence from recent Cochrane reviews and the medical literature since 2007. Many of the previous recommendations regarding early surfactant and CPAP are now more firmly evidence-based. The section on delivery room stabilisation has been considerably expanded. There are new recommendations on delaying umbilical cord clamping and a new section has been added on avoiding or reducing duration of mechanica l ventilation, including recommendations on caf feine t herapy, nasal ventilation, permissive hypercapnia and the role of newer ventilator modalities. A new 'miscellaneous' section has also been added covering aspects of RDS management that arise infrequently.© For permitted use only.

“…Factors associated with the initial growth failure in preterm infants and possible strategies to combat it are reviewed else-where [50] . The growth deficit persists throughout the hospitalization period and growth failure rates in infants with BPD post discharge are estimated to be 30-67% [51] .…”

Section: Growth Failure In Lung Injurymentioning

confidence: 99%

Nutrition and the Lung

Bhatia

Parish²

2009

Self Cite

The use of surfactant replacement, ‘kinder gentler’ modes of ventilation combined with prenatal corticosteroids have all played a role in improved survival rates of very-low-birth-weight infants but have not reduced the prevalence of chronic lung disease. The increased rates of prematurity being observed in the United States along with the increased survival makes the overall problem of treatment of infants with established disease expensive spanning neonatology, pediatric critical care and general pediatrics and involving a myriad of specialists over the life of the surviving infant. However, none of the therapies used over the years have proven to be effective or have long-term adverse effects, nor have they been accepted as methods to prevent chronic lung disease. Although intuitively an appropriate nutritional therapy may be a useful adjunct in the care of the premature sick infant, perinatal malnutrition remains a major problem. The role of nutrition therapy in health and disease as it pertains to the lung will be reviewed.