Postnatal Malnutrition and Growth Retardation: An Inevitable Consequence of Current Recommendations in Preterm Infants?

Abstract

Preterm infants inevitably accumulate a significant nutrient deficit in the first few weeks of life that will not be replaced when current RDIs are fed. This deficit can be directly related to subsequent postnatal growth retardation.postnatal growth retardation, preterm infants.

Growth in preterm infants fed either a partially hydrolyzed whey or an intact casein/whey preterm infant formula

“…1 In many instances, no underlying pathology is detected and feeds are soon restarted. Yet, it takes time to reestablish full intakes and the accrued nutrient deficit increases.…”

“…1 Recent studies suggest that feeding tolerance, as indicated by more rapid gastric emptying, shorter gastrointestinal transit times 2 and shorter time to establish full enteral feeds, 3 is better in preterm infants fed partially hydrolyzed whey (pHW) when compared with preterm infants fed standard intact casein-whey (nonhydrolyzed whey-casein, nHWC) protein-based formulas.…”

Safety and efficacy of early amino acids in preterm <28 weeks gestation: prospective observational comparison

“…[1][2][3][4][5] Inadequate nutrient intake, cumulative energy and protein deficit in the initial days, severity of illness and concurrent administration of drugs (diuretics and steroids) are suspected in the pathogenesis of growth failure. 2,[5][6][7] The majority of energy and protein deficit occurs within the first two postnatal weeks. 5,8 One of the mechanisms for poor growth in the initial days is delay in the initiation of total parenteral nutrition (TPN), especially protein and lipids after birth.…”

“…2,[5][6][7] The majority of energy and protein deficit occurs within the first two postnatal weeks. 5,8 One of the mechanisms for poor growth in the initial days is delay in the initiation of total parenteral nutrition (TPN), especially protein and lipids after birth. Initiation of amino acid (AA) administration at 1.4-1.6g/kg/day immediately after birth and early administration of enteral feeds are the two most important strategies identified to reduce ongoing energy deficit and subsequent growth failure.…”

Post-Discharge Nutrition of Preterm Infants

“…Failure to catch up may also be due to the current way of calculating and delivering nutrient needs. For example, Embleton et al 9 calculated the accrued protein and energy deficits in a cohort of infants. Comparing actual intakes to estimated requirements, they reported deficits of 335±86 kcal/kg and 12±4 g/kg/d for energy and protein, respectively, at 1 week of age in the larger infants.…”