Importance of nutrition in preterm babies
Importance Of Nutrition For Optimal Short And Long Term Outcome In Preterm Infants
In this webinar we shall learn about : Recommended Nutritional Goal For Preterm Babies What is extra uterine growth restriction and its long term adverse effects Issues In VLBW Feeding including choice of Milk, How early to start feeds How much to start with, how to scale up feeds for ELBW & sick babies , how to administer the feeds. How to maintain mother’s milk output Nutritional concerns of VLBW babies and their management.
In this webinar we shall learn about :
Recommended Nutritional Goal For Preterm Babies
What is extra uterine growth restriction and its long term adverse effects
Issues In VLBW Feeding including choice of Milk, How early to start feeds
How much to start with, how to scale up feeds for ELBW & sick babies , how to administer the feeds.
How to maintain mother’s milk output
Nutritional concerns of VLBW babies and their management.
Premature infants have greater nutritional needs to achieve optimal growth in the neonatal period than at any other time in life. The AAP recommends that extra uterine growth of a preterm baby should parallel the intrauterine growth trajectory of a fetus of comparable GA without stressing the developing metabolic or excretory system.
However there are certain inherent limitations of the VLBW baby precluding optimal nutritional intake and optimal growth. These include: Limited nutrient stores, High metabolic needs Catabolic effects of illness due to associated problems like RDS, sepsis apnea Immature metabolic pathways & osmolar limitations
Immature GI tract, Incoordination of suck swallow breathe cycle. Requirement for increased nutrient intake for rapid growth.
Hence the preterm baby is very likely to develop cumulative deficits in protein & energy resulting in slower growth. Large proportion of ELBW & VLBW babies develop Extra Uterine Growth Restriction EUGR defined as weight < 10th centile at 36 weeks PMA or at discharge.
Problems Associated Extra Uterine Growth Restriction
Extra Uterine Growth Restriction is associated with several problems including
Long term adverse neuro-developmental sequelae
Increased risk of ROP
Poor bone health
Lower final weight & height at 20 years of age.
Increased Post Natal Growth: Adult metabolic syndrome.
Lets us understand the risks involved in a little more detail.
EUGR & ROP
Coming to the association of EUGR & ROP: An Increased risk of type 1 ( Severe type) of ROP in extremely low gestational age newborns was observed when intake of total calories, lipids, and carbohydrates as well as the growth velocity in the first month were in the lowest quartile . Improving the early nutrition in ELGAN babies may help prevent development of sight-threatening ROP.
EUGR & Lower Final Weight & Height. Prematurity & LBW also increase the risk of underweight, stunting and wasting . One study showed that at 6 months of age, 28% of the study cohort of VLBW babies showed underweight and stunting and 22% had wasting.
In a study by Hack, VLBW infants were twice as likely to have final height less than the third percentile at 20 years of age, than normal birth weight controls (10 versus 5 %).
Though rapid catch up growth is associated with better neuro developmental outcomes, studies have shown that babies with low weight in neonatal period, showing rapid catch up growth in infancy, show a high incidence of coronary heart disease, Type II diabetes mellitus, Hypercholesterolemia,Hypertension & stroke in adulthood also known as the metabolic symdrome.
Common Issues that need to be addressed In VLBW feeding include:
Which Milk? How early to start feeds ? How much to start with ? How to maintain mother’s milk output. Adequacy of pre-term mother’s milk to sustain adequate growth.
Choice Of milk for preterm babies is definitely mothers own milk (MOM). Mothers own milk (MOM) is best suited to specific nutritional needs of the preterm baby , especially for initial few weeks as it has higher protein, sodium, chloride & magnesium levels, adequate taurine and cysteine for growth & neuronal & retinal maturation, enzymes, including lipases that enhance lipolysis and fat absorption, LCPUFA for cerebral and retinal functions & oligosaccharides for neuronal development, somatic growth, and development of intestinal immunity
Preterm milk also has numerous antimicrobial factors, nucleotides, growth factors and hormones resulting in lower incidence of sepsis, feed intolerance, necrotizing enterocolitis, bronchopulmonary dysplasia, retinopathy of prematurity, lower mortality rates, fewer hospital readmissions for illness in infancy, Lower neurodevelopmental disabilities & better MDI, PDI Human milk fed VLBW babies also show better intellectual performance scores at 7.5 to 8.0 compared to preterm formula fed babies .
- Introduction...
- 1. Importance of n...
- 2. Learning object...
- 3. Recommended nut...
- 4. Inherent limita...
- 5. The result.......
- 6. Problems associ...
- 7. Increased risk ...
- 8. Increased risk ...
- 9. Osteopenia of P...
- 10. Neuro-developm...
- 11. EUGR & lower f...
- 12. Long term adve...
- 13. In conclusion...
 |
 |