Early aggressive nutrition in the neonate.

Abstract

1. Patti J. Thureen, MD* 1. 2. *Associate Professor, Department of Pediatrics, University of Colorado Health Sciences Center, Denver, CO. After completing this article, readers should be able to: 1. Describe the possible long-term effects of suboptimal nutrition in preterm infants and critically ill term neonates. 2. Explain why the current standard for postnatal nutrition in preterm infants may not be adequate for postnatal growth. 3. List the the lower limit at which to start intravenous protein delivery in very low-birthweight infants. 4. Characterize the commonly used definition for minimal enteral nutrition. 5. List the advantages of minimal enteral nutrition compared with exclusive total parenteral nutrition for the neonate. Nutritional practices vary dramatically among neonatal intensive care units (NICUs) in the United States. In many institutions, nutrition is introduced only gradually over the first weeks of life because of concerns of nutrient intolerance by the very preterm or ill infant who is fed intravenously and the risk of necrotizing enterocolitis (NEC) in preterm infants who are fed enterally. Often this period of nutritional deficiency is accepted as inevitable in this population. However, such a strategy of cautious nutrition might lead to a period of early malnutrition from which the neonate has a prolonged recovery and may have long-term adverse consequences. In many neonates this period of early nutritional deprivation need not be inescapable. Many neonatologists will consider the early feeding strategies for the NICU population suggested in this article to be somewhat aggressive. The premise for these recommendations for extremely low-birthweight (ELBW) infants is that avoiding early malnutrition has both short- and long-term benefits for the neonate. This strategy involves initiating total parenteral nutrition (TPN) in the first hours after birth and administering it in conjunction with initially small, and then advancing, enteral feedings beginning on the first or second day of life. Use of TPN is a means to achieve rapid, maximal nutrition, and early enteral feedings are designed to prime the gut and …