Elsevier

Seminars in Perinatology

Volume 27, Issue 4, August 2003, Pages 302-310
Seminars in Perinatology

Growth failure in the preterm infant: can we catch up?

https://doi.org/10.1016/S0146-0005(03)00044-2Get rights and content

Abstract

Postnatal growth failure is extremely common in the very low birth weight and extremely low birth weight infant. Recent data from the National Institute of Child and Human Development (NICHD) Neonatal Research Network indicates that 16% of extremely low birth weight infants are small for gestational age at birth, but by 36 weeks corrected age, 89% have growth failure. Follow-up at 18 to 22 months corrected age shows that 40% still have weights, lengths, and head circumferences less than the 10th percentile. Growth failure is associated with an increased risk of poor neurodevelopmental outcome. Inadequate postnatal nutrition is an important factor contributing to growth failure, as most extremely low birth weight infants experience major protein and energy deficits during the neonatal intensive care unit hospitalization, in spite of the fact that nutrition sufficient to support intrauterine growth rates can generally be provided safely. Aggressive nutritional support —parenteral and enteral— is well tolerated in the extremely low birth weight infant and is effective in improving growth. Continued provision of appropriate nutrition (premature formula or fortified human milk) is important throughout the neonatal intensive care unit stay. After discharge, nutrient-enriched postdischarge formula should be continued for approximately 9 months post-term. Exclusively breast-fed infants require additional supplementation/fortification postdischarge as well. Additional trials are needed to address a number of important questions concerning the role of nutrition and growth on ultimate development.

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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