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Enteral Nutrition Support of the Preterm Infant in the Neonatal Intensive Care UnitFrom the 1 MetroHealth Medical Center at Case Western Reserve University School of Medicine, Cleveland, Ohio,2 Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio. Correspondence: Address correspondence to: Sharon Groh-Wargo, MetroHealth Medical Center, Department of Pediatrics, 2500 MetroHealth Dr, Cleveland, OH 44109; e-mail: sgrohwargo{at}metrohealth.org.
The delivery of a preterm baby is a nutrition emergency. Growth and the accumulation of nutrient reserves are higher during the third trimester of pregnancy than at any other time during the life cycle. Enteral nutrition is the preferred mode of support and human milk the preferred source of enteral nutrition. Human milk is highly digestible and contains many anti-infective components, which confer a lower risk of infection. The mother of a preterm infant requires education, equipment, and encouragement to successfully initiate and sustain lactation. Human milk requires nutrient fortification to meet the protein and mineral needs of the rapidly growing preterm infant. Commercial human milk fortifiers are available. If human milk is unavailable or the volume is insufficient, preterm formulas are available. Preterm formulas have different sources of macronutrients and greater density of all nutrients than formulas intended for term newborns. Preterm infants benefit from early enteral feedings with slow but steady increases in feedings to achieve full support. Infants born at <35 weeks gestational age are supported with tube feedings. A transition to feedings at the breast or to bottle feedings is gradually made as the baby matures. Nutrient recommendations specific to the preterm infant are available. Special products and feeding strategies exist to respond to common medical conditions that can complicate nutrition management. Optimal nutrition care of the preterm infant offers the opportunity to improve outcomes for children.
Key Words: breast feeding • breast milk • enteral nutrition • infant formula • infant • low birth weight • very low birth weight, extremely low birth weight • intensive care units • neonatal • intensive care • human milk • premature birth
Nutrition in Clinical Practice, Vol. 24, No. 3,
363-376 (2009) |
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