Nutritional Strategies for the Very Low Birthweight Infant


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Introduction

Fluid and electrolytes management Na, Cl and K ; 3. Energy; 4.


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Intravenous carbohydrates; 5. Intravenous lipids; 6. Early total parenteral nutrition TPN ; 7. Parenteral calcium, phosphorous, magnesium and Vitamin D; 8. Parenteral vitamins; 9. Trace elements and iron; Parenteral nutrition guide; Parenteral nutrition-associated cholestasis in VLBW infants; Enteral nutrition; Enteral feeding guidelines pPracticum; Optimizing enteral nutrition: protein; Human milk; Premature infant formulas; Standard infant formulas; Soya formulas; Protein hydrolysate formulas; Enteral calcium, phosphorus, magnesium and Vitamin D; Iron; Hypercaloric feeding strategy; Growth in the neonatal intensive care unit influences neurodevelopmental and growth outcomes; Nutritional assessment; Post discharge strategies; Nutritional management of preterm infants with short bowel syndrome; Therefore, 29 infants 14 fed fortified human milk and 15 fed preterm formula underwent the growth and body composition assessment at the term-corrected age.

Parents reported neither feeding intolerance nor any health problems in any of the infants. Anthropometric growth parameters were similar in the 2 groups, whereas a different body composition was observed. In particular, fortified human milk—fed infants showed a higher percentage of fat-free mass, whereas fat-free mass content grams did not differ according to feeding regimen.

Anthropometric and body composition parameters at the term-corrected age according to feeding regimen 1. The results of the present study indicate that infants fed human milk show a higher protein balance associated with greater protein storage but lower protein oxidation in comparison to formula-fed preterm infants at discharge.

These findings suggest that being fed human milk, once adequate protein and energy intakes are provided, promotes the utilization of proteins towards accretion rather than oxidation in stable, healthy preterm infants. Furthermore, using linear regression analysis, being fed human milk between discharge and the term-corrected age was independently associated with a gain in fat-free mass content at the term-corrected age of g.

Therefore, despite a growth similar to formula-fed infants until discharge, growth of fortified human milk—fed infants after discharge seems to be accompanied by a preferential fat-free mass deposition.

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Implementation of Nutritional Strategies Decreases Postnatal Growth Restriction in Preterm Infants

On the basis of the present findings, it can be speculated that being fed human milk promotes tissue growth due to the well-known optimal utilization of nutrients from human milk. As a consequence, being fed human milk until they reach stable clinical conditions could promote fat-free mass deposition in infants, suggesting a potential cumulative effect of human milk consumption on body composition development between discharge and the term-corrected age.

The positive effect of human milk could be further enhanced by the fact that the preterm infants enrolled in the present study were not affected by comorbidities and were exposed to favorable environmental conditions after they were discharged home. Our findings are consistent with previously published data. Larcade et al. Accordingly, Huang et al. The authors found significantly lower fat mass in breastfed infants in comparison to formula-fed infants mean difference: 0.

In contrast, Gale et al. However, it must be taken into account that very preterm infants need to complete their organ development, which has been abruptly interrupted by premature birth In addition, it has been demonstrated that they present a lack of fat-free mass content at the term-corrected age. Therefore, the promotion of fat-free mass accretion by the consumption of human milk may represent an additional physiological compensatory mechanism aimed at recovering body composition, which contributes to the modulation of later health outcomes and promotes neurodevelopment.

Previous studies investigated protein balance according to the feeding regimen in preterm infants 36— Contrary to our results, no benefit was reported in human milk—fed infants in comparison to formula-fed infants. However, the protein and energy intakes assumed by the preterm infants included in the studies did not actually comply with their high nutritional requirements, limiting protein accretion.

Indeed, one strength of our study is that all infants received adequate protein and energy intakes, which were able to meet their high nutritional requirements for growth. Furthermore, through nutritional human milk analysis, we determined the actual protein intakes received by the human milk-fed infants.

While this study is of clinical interest, it has some limitations. First, we included only very preterm infants not affected by comorbidities; thus, the effect of comorbidities on body composition development was not evaluated. Furthermore, body composition was evaluated only at the term-corrected age, and the long-term effect of human milk feeding was not investigated. In conclusion, the findings from this study suggest that once adequate protein and nonprotein energy intakes are provided, human milk feeding is associated with early fat-free mass deposition in healthy and stable very preterm infants.

Therefore, healthcare professionals should direct efforts toward promoting and supporting breastfeeding in these vulnerable infants. Future studies are desirable to confirm these results and to better explore the long-term effect of human milk consumption on body composition development in very preterm infants, with particular focus on infants at increased risk for altered postnatal growth and body composition, such as preterm infants affected by comorbidities.

None of the authors reported any conflict of interest related to the study. Oxford University Press is a department of the University of Oxford. It furthers the University's objective of excellence in research, scholarship, and education by publishing worldwide. Sign In or Create an Account. Sign In. Advanced Search. Article Navigation.

ISBN 13: 9780521732468

Close mobile search navigation Article Navigation. Volume Article Contents. Protein use and weight-gain quality in very-low-birth-weight preterm infants fed human milk or formula Laura Morlacchi. Address correspondence to LM e-mail: laura. Oxford Academic. Google Scholar.

Nutritional Strategies for the Very Low Birthweight Infant (Cambridge Medicine (Paperback))

Paola Roggero. Beatrice Bracco. Debora Porri. Enrico Battiato. Camilla Menis. Nadia Liotto. Domenica Mallardi. Fabio Mosca. Cite Citation. Permissions Icon Permissions.

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Open in new tab Download slide. TABLE 1. Open in new tab. TABLE 2. TABLE 3. TABLE 4. TABLE 5. TABLE 6. American Academy of Pediatrics Committee on Nutrition. Google Preview. Enteral nutrient supply for preterm infants: commentary from the European Society for Paediatric Gastroenterology, Hepatology, and Nutrition Committee on Nutrition. Search ADS. Weight growth velocity and postnatal growth failure in infants to grams: — Growth in the neonatal intensive care unit influences neurodevelopmental and growth outcomes of extremely low birth weight infants.

Greater early gains in fat-free mass, but not fat mass, are associated with improved neurodevelopment at 1 year corrected age for prematurity in very low birth weight preterm infants. Effects of varying protein and energy intakes on growth and metabolic response in low birth weight infants. Bioactive proteins in human milk: health, nutrition, and implications for infant formulas. Nutritional needs of the preterm infant: scientific basis and practical guidelines.

Van Goudoever. Short-term growth and substrate use in very-low-birth-weight infants fed formulas with different energy contents. American Academy of Pediatrics Section on Breastfeeding. Effects of breast-feeding compared with formula-feeding on preterm infant body composition: a systematic review and meta-analysis. Estimation of fat-free mass at discharge in preterm infants fed with optimized feeding regimen. A systematic review and meta-analysis to revise the Fenton growth chart for preterm infants. Implementation of nutritional strategies decreases postnatal growth restriction in preterm infants.

Is targeted fortification of human breast milk an optimal nutrition strategy for preterm infants? An interventional study. Evaluation of a mid-infrared analyzer for the determination of the macro- nutrient composition of human milk.


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    Good Nutrition for Mom and her Baby: Update on What to Eat When Breastfeeding

    Effects of quality of energy intake on growth and metabolic response of enterally fed low-birth-weight infants. Longitudinal evolution of true protein, amino acids and bioactive proteins in breast milk: a developmental perspective. Does human milk modulate body composition in late preterm infants at term-corrected age?

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    Nutritional Strategies for the Very Low Birthweight Infant Nutritional Strategies for the Very Low Birthweight Infant
    Nutritional Strategies for the Very Low Birthweight Infant Nutritional Strategies for the Very Low Birthweight Infant
    Nutritional Strategies for the Very Low Birthweight Infant Nutritional Strategies for the Very Low Birthweight Infant
    Nutritional Strategies for the Very Low Birthweight Infant Nutritional Strategies for the Very Low Birthweight Infant
    Nutritional Strategies for the Very Low Birthweight Infant Nutritional Strategies for the Very Low Birthweight Infant
    Nutritional Strategies for the Very Low Birthweight Infant Nutritional Strategies for the Very Low Birthweight Infant
    Nutritional Strategies for the Very Low Birthweight Infant Nutritional Strategies for the Very Low Birthweight Infant
    Nutritional Strategies for the Very Low Birthweight Infant Nutritional Strategies for the Very Low Birthweight Infant

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