Aggressive nutrition of the very low birthweight infant
Section snippets
General considerations
Compared with the abundantly nutrient-supplied fetus, the VLBW infant is invariably undernourished to some degree and for at least some period of time. Because undernutrition is, by definition, unphysiologic and undesirable, it follows that any measure that diminishes it is inherently good, provided that safety is not compromised. This is more than a matter of perspective because the important implication is that measures that increase nutrient intake and thus diminish undernutrition do not
Aggressive nutrition
Aggressive practice is understood either as practice that ranks toward the upper end of the range of established practices, or as practice that goes beyond the established and into untested territory. We have defined aggressive practice in the latter fashion. In pushing beyond the established, we have followed the guiding principle that the transition from fetal to extrauterine life should proceed with minimal, if any, interruption of growth and development. One prerequisite for this to occur
Nutrients needed for achievement of fetal growth
The nutrient deposition (accretion) associated with “postnatal growth that approximates the in utero growth of a normal fetus” can be determined from data on the chemical composition of the human fetus. As a result of efforts by many investigators over the years, there is a plethora of data concerning the chemical composition of the fetal body. Sparks [17] and Forbes [6], [7] have provided comprehensive summaries of the available data from chemical analysis of some 160 fetuses. Gestational age
Parenteral nutrition
Because immaturity of the gastrointestinal tract temporarily precludes substantive nutritional support via the enteral route, nearly all VLBW infants receive PN. This has resulted in a marked improvement of nutrient intakes compared with times when parenteral nutrition was not practiced so universally. From a nutritional point of view, the liberal use of PN has been an unmitigated success. Administration of PN is associated with risks, mainly from infectious complications. When risk-benefit
Enteral nutrition
Because the gastrointestinal tract of the VLBW infant is immature at birth, it is initially incapable of performing full-scale digestion and absorption and is susceptible to necrotizing enterocolitis (NEC). Maturation and adaptation must take place before the gut can assume responsibility for handling the usual feedings. During that period, nutritional support for the infant depends critically on PN. Before PN became available for routine use, VLBW infants routinely experienced severe
Summary
We propose an approach to nutrition of the VLBW infant that aims at minimizing the interruption of nutrient uptake engendered by premature birth. Our approach is aggressive in that it goes beyond current practice in several key aspects. The gap in nutrient intakes between the proposed aggressive approach and current practice will most likely disappear over the next few years as today's aggressive practice becomes tomorrow's standard practice. As the gap diminishes, so will the threat that
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