Nutrition in Clinical Practice http://ncp.sagepub.com/
Nutrition Management for the Promotion of Growth in Very Low Birth Weight Premature Infants Allison Prince and Sharon Groh-Wargo Nutr Clin Pract 2013 28: 659 originally published online 25 October 2013 DOI: 10.1177/0884533613506752 The online version of this article can be found at: http://ncp.sagepub.com/content/28/6/659
Published by: http://www.sagepublications.com
On behalf of:
The American Society for Parenteral & Enteral Nutrition
Additional services and information for Nutrition in Clinical Practice can be found at: Email Alerts: http://ncp.sagepub.com/cgi/alerts Subscriptions: http://ncp.sagepub.com/subscriptions Reprints: http://www.sagepub.com/journalsReprints.nav Permissions: http://www.sagepub.com/journalsPermissions.nav
>> Version of Record - Nov 21, 2013 OnlineFirst Version of Record - Oct 25, 2013 What is This?
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506752
research-article2013
NCPXXX10.1177/0884533613506752Nutrition in Clinical PracticePrince and Groh-Wargo
Invited Review
Nutrition Management for the Promotion of Growth in Very Low Birth Weight Premature Infants
Nutrition in Clinical Practice Volume 28 Number 6 December 2013 659–668 © 2013 American Society for Parenteral and Enteral Nutrition DOI: 10.1177/0884533613506752 ncp.sagepub.com hosted at online.sagepub.com
Allison Prince, MS, RD, LD1; and Sharon Groh-Wargo, PhD, RD, LD2
Abstract Premature infants are highly susceptible to extrauterine growth restriction. Without early and adequate nutrition support, nutrition deficits of energy and protein can quickly accrue. Growth failure has been implicated in poor neurodevelopmental outcomes and long-term morbidity, creating a major focus on neonatal nutrition alongside medical management. Optimal nutrition is paramount for optimal growth outcomes. The purpose of this article is to review the implications and long-term effects of growth failure in premature infants, specifically, those with very low birth weights. In addition, nutrition interventions and treatments will be presented to manage and improve growth outcomes of the neonate. (Nutr Clin Pract. 2013;28:659-668)
Keywords neonates; growth; enteral nutrition; parenteral nutrition; infant, newborn; infant, very low birth weight; nutrition therapy; nutritional support
Growth is by far the number one priority for the preterm infant after medical stability is achieved. The majority of days that a preterm infant is cared for in the neonatal intensive care unit (NICU) are spent “feeding and growing.” In other words, it is the time medical providers use to provide optimal nutrition while trying to achieve adequate growth that mimics that of the third trimester in utero. Expectations for growth of preterm infants are based on well-documented literature that supports optimal brain development, head circumference growth, and neurodevelopmental outcomes in early childhood.1-4 There are 3 times in the lifecycle when growth has long range effects: the intrauterine period, infancy, and adolescence. Failure of the neonate to achieve appropriate gestational growth prenatally is called intrauterine growth restriction (IUGR). Infants who are born with IUGR are often small for gestational age (SGA) (weight for gestational age below the 10th percentile), and very low birth weight (VLBW) (24 hours after birth.44 Amino acids are initially provided at a minimum of 2 g/ kg/day and advanced to 3.5 g/kg/day.2 Infants who receive early amino acid administration of 3 g/kg/day immediately after birth have decreased growth restriction at 36 weeks postconceptional age when compared to infants who receive identical amounts of amino acids after 48 hours of life.44 A significant protein deficit accrues within the first week of life with any delay in providing optimal protein and can be difficult to recoup prior to hospital discharge.12 Total energy, inclusive of calories provided by amino acids, dextrose, and lipids, is provided at 90-100 kcal/kg for VLBW
infants and 105-115 kcal/kg for ELBW infants within several days after birth.2,41 Promptly providing calories greater than basal energy expenditure (assumed to be 45 kcal/kg/day in infants
Nutrition Management for the Promotion of Growth in Very Low Birth Weight Premature Infants Allison Prince and Sharon Groh-Wargo Nutr Clin Pract 2013 28: 659 originally published online 25 October 2013 DOI: 10.1177/0884533613506752 The online version of this article can be found at: http://ncp.sagepub.com/content/28/6/659
Published by: http://www.sagepublications.com
On behalf of:
The American Society for Parenteral & Enteral Nutrition
Additional services and information for Nutrition in Clinical Practice can be found at: Email Alerts: http://ncp.sagepub.com/cgi/alerts Subscriptions: http://ncp.sagepub.com/subscriptions Reprints: http://www.sagepub.com/journalsReprints.nav Permissions: http://www.sagepub.com/journalsPermissions.nav
>> Version of Record - Nov 21, 2013 OnlineFirst Version of Record - Oct 25, 2013 What is This?
Downloaded from ncp.sagepub.com at ANADOLU UNIV on May 1, 2014
506752
research-article2013
NCPXXX10.1177/0884533613506752Nutrition in Clinical PracticePrince and Groh-Wargo
Invited Review
Nutrition Management for the Promotion of Growth in Very Low Birth Weight Premature Infants
Nutrition in Clinical Practice Volume 28 Number 6 December 2013 659–668 © 2013 American Society for Parenteral and Enteral Nutrition DOI: 10.1177/0884533613506752 ncp.sagepub.com hosted at online.sagepub.com
Allison Prince, MS, RD, LD1; and Sharon Groh-Wargo, PhD, RD, LD2
Abstract Premature infants are highly susceptible to extrauterine growth restriction. Without early and adequate nutrition support, nutrition deficits of energy and protein can quickly accrue. Growth failure has been implicated in poor neurodevelopmental outcomes and long-term morbidity, creating a major focus on neonatal nutrition alongside medical management. Optimal nutrition is paramount for optimal growth outcomes. The purpose of this article is to review the implications and long-term effects of growth failure in premature infants, specifically, those with very low birth weights. In addition, nutrition interventions and treatments will be presented to manage and improve growth outcomes of the neonate. (Nutr Clin Pract. 2013;28:659-668)
Keywords neonates; growth; enteral nutrition; parenteral nutrition; infant, newborn; infant, very low birth weight; nutrition therapy; nutritional support
Growth is by far the number one priority for the preterm infant after medical stability is achieved. The majority of days that a preterm infant is cared for in the neonatal intensive care unit (NICU) are spent “feeding and growing.” In other words, it is the time medical providers use to provide optimal nutrition while trying to achieve adequate growth that mimics that of the third trimester in utero. Expectations for growth of preterm infants are based on well-documented literature that supports optimal brain development, head circumference growth, and neurodevelopmental outcomes in early childhood.1-4 There are 3 times in the lifecycle when growth has long range effects: the intrauterine period, infancy, and adolescence. Failure of the neonate to achieve appropriate gestational growth prenatally is called intrauterine growth restriction (IUGR). Infants who are born with IUGR are often small for gestational age (SGA) (weight for gestational age below the 10th percentile), and very low birth weight (VLBW) (24 hours after birth.44 Amino acids are initially provided at a minimum of 2 g/ kg/day and advanced to 3.5 g/kg/day.2 Infants who receive early amino acid administration of 3 g/kg/day immediately after birth have decreased growth restriction at 36 weeks postconceptional age when compared to infants who receive identical amounts of amino acids after 48 hours of life.44 A significant protein deficit accrues within the first week of life with any delay in providing optimal protein and can be difficult to recoup prior to hospital discharge.12 Total energy, inclusive of calories provided by amino acids, dextrose, and lipids, is provided at 90-100 kcal/kg for VLBW
infants and 105-115 kcal/kg for ELBW infants within several days after birth.2,41 Promptly providing calories greater than basal energy expenditure (assumed to be 45 kcal/kg/day in infants
