Pragmatic Approach to In-Hospital Nutrition in High-Risk Neonates

Pattern of daily weights among low birth weight neonates in the neonatal intensive care unit: data from a multihospital health-care system

“…5 We constructed a new postnatal weight chart based on 30 consecutive months of actual weights measured daily on 1813 patients in four NICUs in one health system. We speculated that changes in early fluid management 19,20 and early nutrition, 6 implemented in NICU's during the past decade, likely resulted in less initial weight loss and more rapid gain, particularly in the smallest patients. Indeed, we found differences between the weight changes predicted by the present grid and all previous grids.…”

“…However, nutritional explanations might figure prominently in the later differences, such as fewer days required to gain 100 and 300 g above birth weight. For instance, compared with a decade ago many neonatologists now use earlier administration of intravenous amino acids [6][7][8][9] and earlier use of lipid emulsions. 6,10 Recent advances in infant formulas and human milk fortifiers have been shown to enhance weight gain beyond that seen a decade ago.…”

“…For instance, compared with a decade ago many neonatologists now use earlier administration of intravenous amino acids [6][7][8][9] and earlier use of lipid emulsions. 6,10 Recent advances in infant formulas and human milk fortifiers have been shown to enhance weight gain beyond that seen a decade ago. 11,12 Moreover, shorter initial 'NPO' periods and more consistent enteral Table 3 Pattern of early weight loss, and subsequent gain, among NICU patients in birth weight categories ranging from 500 to 2500 g, as predicted using four postnatal growth grids (48) 10 (28) The columns display the number of days required to gain 100 g above birth weight, and in parentheses are shown the number of days required to gain 300 g above birth weight.…”

“…[6][7][8][9][10][11][12][13][14][15][16][17][18][19][20] On the basis of these, we hypothesized that NICU patients cared for currently have more rapid weight gain than are displayed on the commonly used postnatal grids. [2][3][4][5] To test this we collected, from electronic records, all daily weights of all patients with birth weights 400-2600 g, born during a 30-month period, January 1, 2003-June 30, 2005, cared for in any the NICU's of the Intermountain Health Care (IHC) System.…”

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

“…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. 9 Development of hyperammonemia and metabolic acidosis was reported as concerns in early days of protein solutions administration to preterm neonates. 10,11 However, with changes in the formulations and development of specific AA solutions, these concerns are being challenged.…”