Feeding growth restricted premature neonates: a challenging perspective

Abstract

Nutrition in the postnatal period is essential to achieve optimal growth and maintain biochemical normality. Feeding growth-restricted premature neonates remains a big challenge for pediatricians and neonatologists. The choice of milk is one of the biggest challenges. Breast milk is recommended, although feeding with preterm formulas can ensure a more consistent delivery of optimal levels of nutrients. The timing of introduction of feeds and the rate of advancement of those feeds in preterm infants are both topics of significant controversy. Early feeding is advantageous because it improves the functional adaptation of the gastrointestinal tract and reduces the duration of total parenteral nutrition. A faster rate of advancement will also reduce the duration of need for parenteral nutrition. Despite this, enteral feeding is often delayed and is often slowly increased in high-risk infants because of a possible increased risk of necrotizing enterocolitis (NEC). Growth-restricted neonates are at increased risk of developing NEC due to a combination of antenatal and postnatal disturbances in gut perfusion. If enteral feeding is introduced earlier and advanced more quickly, this may lead to increased risk of NEC, but slower feeds extend the duration of parenteral nutrition and its risks and may have adverse consequences for survival, growth, and development. Premature infants pose a significant nutritional challenge. Overall, we would suggest the preferential use of human breast milk, early minimal enteral feeds, and standardized feeding protocols with cautious advancements of feeds to facilitate gastrointestinal adaptation and reduce the risk of NEC, however further research is needed.

Nutritional Strategies for Preterm Neonates and Preterm Neonates Undergoing Surgery: New Insights for Practice and Wrong Beliefs to Uproot

“…At birth, a targeted supply of nutrients is required to achieve optimal growth and avoid complications. Indeed, nutrient supply through the placenta is compromised in IUGR fetuses, leading to growth restriction [ 66 ]. Prenatal Doppler anomalies are linked to fetal hypoxia and may result in a redistribution of cardiac output, sparing the brain at the expense of splanchnic circulation and potentially predisposing it to gastrointestinal problems [ 67 ].…”

Effect of Designed Nutritional Guidelines on Nurses’ Performance regarding Feeding of LowBirth-Weight Infants

“…The evidence-based oral feed advancement guidelines in the (NICU) helps to minimize variation in feeding practices, promote shortened transition times from gavage to oral feeding, increase bottle-feed quality, and decrease the length of stay in the NICU. The benefits of these guidelines lies in the fact they offer comprehensive nutritional support through a combination of early TPN and early enteral feeding, followed by a steady decrease in TPN as the amount of enteral feed then increased gradually ( Paul et al, 2018).…”

Implementation of the Reimbursement Cost of Human-Milk-Based Neonatal Therapy in Polish Health Care Service

“…Hence, nutritional therapy is a key factor in newborn intensive care. In order to ensure that the dynamically changing nutritional requirements of preterm infants are met, parenteral feeding is established from the beginning (Brennan et al, 2016;Paul et al, 2018). However, it is recommended that preterm infants be introduced to enteral feeding (any way of providing food via the gastrointestinal tract), initially as minimal enteral feeding (MEF), as soon as possible (Hay, 2018).…”