Adamkin: Nutritional Strategies for the Very Low Birthweight Infant

Neonatology as a subspecialty was established in 1975. There have been adventures and misadventures. There have been advances and declines. However, with a greater understanding of normal development and physiology, the improvements in technology and the utilization of evidence-based medicine, our subspecialty continues to thrive. Much of our success has been due to the better use of ventilation techniques and the development of newer antibiotics to treat infectious conditions.
This book provides a clinical practicum to implement parenteral and enteral feeding guidelines for aggressive nutrition to prevent extrauterine growth failure of the very low birthweight (VLBW), =1500 gram infant. These strategies promote the goals of reducing postnatal weight loss, earlier return to birthweight, and improved catch-up growth. The guiding principle for these strategies is that undernutrition is, by definition, non-physiologic and undesirable. It follows that any measure that diminishes undernutrition is inherentlygood provided that safety is not compromised. Further, this book will review available evidence concerning the controversy of rapid early growth leading to visceral adiposity and metabolic/cardiovascular morbidity in adolescence and adulthood.
Although current guidelines for the growth of preterm infants use intrauterine growth as the reference standard, the growth of most preterm and VLBW infants proceeds at a slower rate than in utero. Although many of the smallest VLBW infants are also born small for gestational age (SGA), both appropriate-for-gestational-age VLBW and SGA infants develop extrauterine growth restriction. From the National Institute of Child Health and Human Development (NICHD) Neonatal Research Network, demonstrates the differences between intrauterine growth and the observed rates of postnatal growth in the NICHD study. The postnatal growth curves are shifted to the right of the reference curves in each gestational age category. This “growth deficiency” is common in extremely low birthweight (ELBW) infants (=1000 gram birthweight ).

It was known early on that nutrition was an essential part of our equation for success. With the increasing survival of premature and extremely premature infants and the increasing incidence of prematurity, nutrition as an adjunct to the care of the tiny premature infant is of paramount importance. Appropriate nutritional therapy should allowfor maximum growth without adverse effects and evidence suggests that infants who grow at the highest quartiles have better neurocognitive outcomes. It is also well recognized that extrauterine growth restriction due to other morbidities and inadequate nutritional intervention can lead to poor outcomes. The full-term infant and late-preterm infant have multiple avenues available to provide adequate nutrition for growth. However, the preterm and especially the extremely low birthweight infant (ELBW) still present great challenges. This monograph entitled “Nutritional Strategies for the Very Low Birthweight Infant” presents a method to understand the complexity of nutrition in this gestational age and weight group and to provide “strategies” for therapy. The chapters discuss energy, the basic components of nutrition (carbohydrate, protein, fat), vitamins, minerals and trace elements. In addition, there is information regarding human milk, infant formulas and influences on neurodevelopmental and growth outcomes. Each chapter provides the reader with recommendations and guidelines for therapy. This monograph is intended for the caregiver of a neonate, from a medical student or dietitian to the advance practice nurse and neonatologist. The material presented is based on evidence for best practice and provides guidelines for nutritional intervention in this very vulnerable group of neonates.

Contents
1 Introduction
2 Fluid and electrolyte management (Na, Cl and K)
3 Energy
4 Intravenous carbohydrates
5 Intravenous lipids
6 Early total parenteral nutrition (TPN)
7 Parenteral calcium, phosphorus, magnesium, and vitamin D
8 Parenteral vitamins
9 Trace elements and iron
10 Parenteral nutrition guide
11 Parenteral nutrition-associated cholestasis in VLBW infants
12 Enteral nutrition
13 Enteral feeding guidelines practicum
14 Optimizing enteral nutrition: protein
15 Human milk
16 Premature infant formulas
17 Standard infant formulas
18 Soya formulas
19 Protein hydrolysate formulas
20 Enteral calcium, phosphorus, magnesium, and vitamin D
21 Iron
22 Hypercaloric feeding strategy
23 Growth in the neonatal intensive care unit influences neurodevelopmental and growth outcomes
24 Nutritional assessment
25 Post-discharge strategies
26 Nutritional management of preterm infants with short bowel syndrome
27 Summary
Index

Glossary

• ARA arachidonic acid
• BPD bronchopulmonary dysplasia
• CPAP continuous positive airway pressure
• DBM donor breast milk
• DHA docosahexanoic acid
• ECW extracellular water
• EFAD essential fatty acids deficiency
• ELBW infant birthweight = 1000 g
• FFA/ALB free fatty acid: albumin ratio
• FFA free fatty acids
• GIR glucose infusion rate
• GRV gastric residual volume
• ICW intracellular water
• IUGR intrauterine growth restriction
• IVL intravenous lipid
• MEN minimal enteral nutrition
• NEC necrotizing enterocolitis
• NPC nonprotein calories
• PDA patent ductus arteriosis
• PDF post-discharge formula
• PNAC parenteral nutrition-associated cholestasis
• PPHN persistent pulmonary hypertension
• PTF preterm formula
• PUFA polyunsaturated fatty acids
• RMR resting metabolic rate
• RTBW return to birthweight
• SGA small for gestational age
• TBW total body water
• TF term formula
• TPN total parenteral nutrition
• TPNAC total parenteral nutrition-associated cholestasis
• UAC umbilical artery catheterization
• VLBW  very low birthweight

Book Details

• Paperback: 208 pages
• Publisher: Cambridge University Press; 1 edition (September 28, 2009)
• Language: English
• ISBN-10: 0521732468
• ISBN-13: 978-0521732468
• Product Dimensions: 7.3 x 4.8 x 0.8 inches

List Price: $44.99