Growth failure in the preterm infant: can we catch up?
Section snippets
Growth failure in the very low birth weight population
As intrauterine growth restriction or small for gestational age (SGA) is defined as less than the 10th percentile for weight at a given gestational age, we have similarly defined postnatal growth failure as body weight less than the tenth percentile for completed weeks of gestation according to the intrauterine growth data reported by Alexander et al.8 We also used growth parameters less than the 10th percentile for the National Center for Health Statistics (NCHS) growth standards to define
Nutrient requirements of the extremely low birth weight infant
Until relatively recently, little information has been available regarding the energy and nutrient requirements of the ELBW infant, particularly early in postnatal life. This lack of data was due in large part to technical challenges in performing such studies. However, in the last several years, the energy, protein and other macronutrient requirements of the extremely preterm infant have been defined in considerable detail.6 The basal energy expenditure of the relatively stable ELBW infant in
Questions for future research
While aggressive early parenteral and enteral nutrition appears to be an effective and safe strategy for supporting ELBW infants, further refinements in the profile of amino acids and other nutrients are likely to be needed. Defining the exact amino acid requirements and ensuring that they are presented in proper balance in parenteral nutrition solutions remains an important issue. It is critical that adequate amounts of all essential amino acids are provided, but currently we do not know if
Summary
Postnatal growth failure occurs in the vast majority of ELBW infants. While the pathogenesis of such growth failure is clearly multifaceted, inadequate nutritional support is a significant factor—and one that we can address. We know a great deal more about what constitutes safe and effective nutrition for these infants than we did 10 years ago. Nonetheless, translating that knowledge into practice remains a challenge.
Acknowledgements
We especially thank the Follow-up Principal Investigators and Follow-up Coordinators of the NICHD Neonatal Research Network.
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