Nutrition Management of the Very Low-birthweight Infant

Abstract

After completing this article, readers should be able to: 1. Describe the conditions that early amino acid infusions can prevent in neonates. 2. Describe the effects of minimal enteral nutrition on time to full feedings and length of hospitalization. 3. Explain the clinical usefulness of gastric residuals in very low-birthweight infants. 4. Explain the benefits of gut stimulation protocols for extremely low-birthweight infants (500 to 600 g). This review of nutrition management of very low-birthweight (VLBW) infants (<1,500 g) examines two of three important strategies in a time line configuration (Fig. 1). This covers the first hours and days after birth through the end of the first postnatal year. Figure 1. Aggressive nutrition to prevent extrauterine growth restriction. PWL=postnatal weight loss, RTBW=return to birthweight, TPN=total parenteral nutrition, D/C=discharge, IWL=insensible water loss, CAPS=baby hats, ICF=intracellular fluid, AA=amino acids, E/N=energy/nutrition, PTF=preterm formula, H.C.=head circumference. Reprinted with permission from Adamkin DH. J Perinatol. 2005;25(suppl):S7–S11. The goal of nutrition management in VLBW infants, which is supported by the American Academy of Pediatrics Committee on Nutrition, is the achievement of postnatal growth at a rate that approximates the intrauterine growth of a normal fetus at the same postconceptional age. In reality, however, the growth of VLBW infants lags considerably after birth. Such infants, especially those weighing less than 1,000 g at birth (very, very low-birthweight [VVLBW]), typically do not regain birthweight until 2 to 3 weeks of age. The growth of most VLBW infants proceeds at a slower rate than in utero, often by a large margin. Although many of the smallest VLBW infants are also born small for gestational age (SGA), both appropriate-for-gestational-age VLBW and SGA infants develop extrauterine growth restriction. Figure 2, from the National Institute of Child Health and Human Development (NICHD) Neonatal Research Network, demonstrates the differences between normal intrauterine growth and the observed rates of …