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Artificial Nutrition in Very Low Birth Weight Newborns and Impact on Growth: Practical Methods to Avoid and Treat Malnutrition in Stable and Unstable Neonates

Chapter

Abstract

Artificial nutrition is essential for survival and growth of very low birth weight (VLBW) infants when the life is characterized by clinical instability and natural nutrition is practically impossible. Malnutrition of VLBW newborns is a universal problem. The goal of each artificial nutrition is just to optimize growth and assure neurodevelopment. Accepted standard for postnatal growth is the intrauterine growth. Early high amino acid and energy intake are required to support intrauterine rates of weight gain and protein accretion. During the phases of clinical instability, parenteral nutrition represents the main source of nutrition and the use of enteral nutrition is limited. However, early administration of adequate enteral support may reduce the detrimental consequences of starvation. A minimal enteral feeding (MEF), consisting in 10–20 ml/kg/day, could be started in the first 24 h and slowly increased (20–30 ml/kg/day), until full enteral feeding (120 kcal/kg/day) is reached. MEF has several advantages when compared with total parenteral nutrition including maintenance of many intestinal functions and decreased risk of infections in VLBW newborns. Parenteral nutrition is administered to maintain adequate fluid, electrolytes, and nutrients intake, until full enteral feeding is reached. High amino acid intake in the first hours of life results in a shorter duration of total parenteral nutrition (TPN), in a greater weight, length and head circumference at 36 weeks of postconceptional age, and in a greater head circumference at 18 months corrected age, when compared to low intake of amino acids. When the newborn is stable, during growing period, daily protein and energy intakes of 3.2–3.8 g/kg and 90–100 kcal/kg (parenteral) and 3.4–4.2 g/kg and 110–130 kcal/kg (enteral) are recommended for VLBW infants. Daily protein and energy intakes for extremely low birth weight (ELBW) infants are thought to be higher at 3.5–4.0 g/kg and 105–115 kcal/kg (parenteral) and 3.8–4.4 g/kg and 130–150 kcal/kg (enteral), respectively. If the protein to energy ratio is not in the optimal range, there can be undesirable long-term consequences such as obesity, diabetes, and hypertension. Thus, early nutritional interventions could have beneficial or detrimental consequences on the health status of the subsequent age of life. Anthropometric measurements associated with new laboratory and radiological tools could be useful to verify not only growth but also a correct body composition during such nutritional intervention. The optimum is to adopt an individualized nutritional support tailored to the needs of the single VLBW neonate in order to promote growth and reduce complications for subsequent ages of life.

Keywords

Premature Infant Parenteral Nutrition Human Milk Enteral Nutrition Artificial Nutrition 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Abbreviations

ADP

Air displacement plethysmography

AGA

Appropriately grown for gestational age

AP

Alkaline phosphatase

BIA

Bioelectrical impedance analysis

BPD

Bronchopulmonary dysplasia

BUN

Blood urea nitrogen

CRBSI

Intravascular catheter-related bloodstream infections

CVC

Central vascular catheter

DEXA

Dual-energy x-ray absorptiometry

ELBW

Extremely low birth weight

GA

Gestational age

IGF

Insulin growth factor

IL

Intravenous lipid

IUGR

Intrauterine growth-restricted infants

LCPUFA

Long-chain polyunsaturated fatty acids

MAC

Mid-arm circumference

MEF

Minimal enteral feeding

NEC

Necrotizing enterocolitis

NI

Nutrient intakes

PDA

Patent ductus arteriosus

PN

Parenteral nutrition

RBP

Retinal binding protein

SGA

Small for gestational age

TBW

Total body water

TOBEC

Total body electrical conductivity

TPN

Total parenteral nutrition

TSF

Triceps skin fold

VLBW

Very low birth weight

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Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  1. 1.Department of Women Health and Territorial MedicineUniversity of Rome “La Sapienza”RomeItaly
  2. 2.Department of PediatricsUniversity of Naples Federico IINaplesItaly
  3. 3.V. Monaldi HospitalNaplesItaly

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