New Perspectives in Neonatal Nutrition

Abstract

Modern techniques of cardiopulmonary life support, particularly for very low birthweight infants and those suffering from major surgical conditions, has presented the neonatologist with a completely new population of infants for whom continued survival and further normal physical and mental growth and development are critically dependent on adequate nutrition. The uncertainties surrounding the definition of ‘adequacy’ as well as the techniques and difficulties of its attainment and assessment are exposed. This paper examines desirable goals to be aimed for in the nutrition of the neonate in relation to genetic potential for growth, development and body composition. There is discussion of current research into the intermediary metabolism and utilisation of macronutrients and certain minerals for energy production and tissue growth and of methodology for determining body composition. The editor has also allowed a certain licence for speculation concerning future directions in neonatal nutrition.

Metabolic Response to Surgery in Infants and Children

“…Their physiology in terms of thermoregulation, postoperative metabolic changes, and fl uid and energy requirements can be very diff erent to adults, and even within these diff erent age groups. The newborn infant is in a " critical epoch " of extra-uterine adaptation and postnatal development, not only of the organism as a whole but also of the individual organs, most signifi cantly the brain [1] . The older infant has adapted to its extra-uterine environment, but is still growing and adapting his or her physiological and nutritional needs to balance growth and development with the stresses imposed upon its changing homeostasis.…”

Nutrition of the preterm baby

“…Under‐nutrition is known to affect both lung growth and development (Frank & Sosenko 1988) and respiratory muscle function (Wilson et al 1992a). It also leads to an impairment of defence against infection, alters the oxidant‐antioxidant defence system (Frank & Sosenko 1988), affects long term growth (Swyer 1987), and neurodevelopment (Lucas et al 1990) and may have a significant bearing on the development of disease in later childhood and adulthood (Barker 1992). The problem is further compounded for the neonatologist by an inadequate knowledge of energy requirements in very low birthweight babies in health and disease and a limited corpus of knowledge of neonatal biochemistry.…”