Research : Early agressive nutrition;

">

Patti Thureen, MD

C.H.O.P.

The argument for delivering early aggressive nutrition to the high-risk, very preterm newborn is based on the observation that nationally, we are producing postnatal growth retardation that is not reversed by the time of hospital discharge. High protein requirements, fluid losses, and energy expenditure combined with small energy reserves and poor gastrointestinal motility in these infants constitute a nutritional emergency. On the other hand, concerns about intolerance and toxicity (especially necrotizing enterocolitis) remain, and clear evidence about long-term benefit is lacking.

The standard of the American Academy of Pediatrics for postnatal nutrition in preterm infants is to duplicate normal in utero fetal growth rates, but no detailed guidelines for reaching this goal have been published. Dr. Thureen explained that normal fetal growth rate is difficult to achieve in extremely low birth weight infants and that weight gain alone does not guarantee “good growth.” She advocates the following steps in early aggressive nutritional support:

• Start total parenteral nutrition on the first day of life
• Give amino acids to prevent catabolism and in amounts that, hopefully, produce growth
• Advance glucose and lipids as rapidly as tolerated
• Give minimal enteral feedings (MEF) on days 1 and 2
• Aim for a “good” weight gain of 15 to 20 g/kg/day by days 10 to 12

Dr. Thureen stated that protein growth may be the best indicator of “real” growth, and evidence suggests that the amount of protein intake early in life correlates with developmental outcome. She and her colleagues compared the results of low and high intravenous amino acid intake in extremely low birth weight infants in the first 48 hours of life. Significantly greater rates of protein accretion occurred in neonates who received high amino acid intake (3 g/kg/day) compared with those who received the lower amount (1 g/kg/day); no evidence of toxicity was found .

Finally, Dr. Thureen discussed the role of MEF, also called “priming” or “trophic feedings,” in which formula or breast milk is given enterally in amounts from <1>

http://www.ncbi.nlm.nih.gov:80/pmc/articles/PMC1200660/ (i researched this site today)