Feeding the Preterm Neonate with Intrauterine Growth Restriction

Chapter

Abstract

Intrauterine growth restriction (IUGR) is the failure to achieve the genetically predetermined growth potential and may be caused by fetal, maternal, placental, and external factors. IUGR is associated with significant perinatal mortality and morbidity and adverse long-term outcomes, in preterm, especially extremely preterm infants with gestation under 28 weeks at birth. Optimal enteral feeding is crucial in this population as suboptimal nutrition during a critical phase of postnatal life is associated with a negative impact on long term neurodevelopment. However, enteral nutrition is a difficult issue in these infants considering the adverse effects of chronic hypoxia on the fetal gastrointestinal tract, and the inherent susceptibility of this high-risk population to a potentially devastating illness such as necrotising enterocolitis (NEC). Signs of feeding intolerance such as abdominal distension, large/bile stained gastric residuals are almost universal in the first week or two in extremely preterm IUGR infants and are difficult to differentiate from early NEC. This is also the period when suboptimal nutrition constitutes a nutritional emergency. Animal data associate IUGR with reduced intestinal weight (proportionate to body weight), length and wall thickness, and reduced villous height and crypt depth at the microscopic level. Initial observations on a distinct gut colonization pattern may also be relevant to the specific health hazards in this population. This chapter reviews the current strategies for enteral feeding, and the potential long term adverse effects of catch up growth (e.g., increased risk of obesity, hypertension and diabetes mellitus) in the preterm infant with IUGR.

Keywords

Short Chain Fatty Acid Enteral Feeding Crypt Depth Placental Insufficiency Villous Height 
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.

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Copyright information

© Springer Science+Business Media Dordrecht 2013

Authors and Affiliations

  • Flavia Indrio
    • 1
  • Luca Maggio
    • 2
  • Francesco Raimondi
    • 3
  1. 1.Department of PediatricsUniversity of BariBariItaly
  2. 2.Division of NeonatologyUniversità Cattolica del Sacro CuoreRomeItaly
  3. 3.Department of Medical Translational MedicineUniversità “Federico II”NaplesItaly

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