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Iowa Neonatology Handbook: Feeding
Nutritional Management of the Preterm Infant
Ekhard E. Ziegler, MD
Peer Review Status: Internally Peer Reviewed
Recent years have seen marked changes in the general approach to the nutritional
management of preterm infants. The changes reflect a growing awareness of the
potential for adverse consequences from starvation and undernutrition during
the neonatal period. There can be no doubt that neurodevelopmental processes
are susceptible to nutritional insults.
The temporary postnatal growth arrest, which we have come to accept as inevitable,
is potentially preventable, if not in its entirety, then at least to a large
degree. Somatic growth is a useful indicator of nutritional sufficiency. When
somatic growth is near normal, significant nutritional insults to the CNS are
unlikely. On the other hand, when somatic growth is abnormal, there is always
the possibility of adverse effects on neurodevelopment. Therefore, nutritional
efforts aimed at enabling somatic growth as it would have occurred in utero
are well justified because they enhance the chance that growth and development
of
the CNS will continue without interruption.
The trend in recent years has been towards earlier and more aggressive use
of parenteral nutrition. This was made possible by expanded use of percutaneously
placed central vein catheters. An innovation in enteral feedings has been the
use of "trophic" feedings starting very soon after birth. The idea
is to prevent intestinal atrophy from occurring, so that, when feedings start
in earnest, the gut does not have to go through a lengthy rehabilitation period.
Together these two developments have made for greatly improved nutritional management,
especially of very small preterm infants.
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