Nutritional care of preterm infants: Scientific basis and practical guidelines

Abstract

With the increasing survival of preterm infants the concept of “neurological intact survival” rather than just ‘survival’ has become important. Along with initiation of advanced cardio-respiratory support, a physician caring for a preterm infant is met with day-to-day challenges in replicating the in utero nutritional needs of these vulnerable preterm infants for optimal growth and neurodevelopment. This book is a part of the 110th volume of “World Review of Nutrition and Dietetics” series and has been written and edited by several world renowned neonatologists and nutrition specialists. The book looks at the nutritional needs of the preterm infants, an area where much is still unclear. The chapters are arranged in a logical sequence, starting with historical perspectives, defining the nutritional needs and looking at nutrition, growth and outcome of preterm infants. Subsequent chapters deal with each component of nutrition (water, carbohydrates, fats, proteins, vitamins & minerals, including trace elements) which has been discussed and elaborated citing recent references and trials. Conventional uses and newer insights regarding the use of several vitamins have also been discussed. The chapters on gut microbiota, necrotizing enterocolitis (NEC) and the role of pre- and probiotics have been written in a well balanced manner. This is important in this era where many neonatologists have started using probiotics without looking into this type and dose. Nutrition and its effect on the brain and lung has also been addressed and the various challenges met during growth faltering of preterm infants and postdischarge nutrition have been discussed. Of use for readers from India is the chapter on meeting the challenges of preterm nutrition in low resource settings. This chapter has addressed the common problem of lack of total parenteral nutrition, human milk and human milk fortifiers and has provided a pragmatic and practical approach which will be useful for practitioners in India. What is useful is that each chapter is summarized at the end with a practical recommendation which will be appreciated by clinicians and students. There are also research suggestions in each area of preterm nutrition which can stimulate research in areas where evidence is lacking. However, in some of the chapters, the title does not provide the reader with an insight into its contents. Also the chapter, “Assessing the Evidence from Neonatal Nutrition Research” does not fit in well with the flow of the book. In summary, this book provides a practical and comprehensive evidence-based review of nutritional care of preterm infants from the time of birth extending until early infancy and will be especially useful to practicing neonatologists, paediatricians and medical students.