Focus Module – Nutritional Care of Preterm Infants
Preterm birth, birth that occurs <37 completed weeks’ gestation, is a major global public health problem. With an incidence that ranges from 5-18% across the world, preterm birth is a major cause of death in children under the age of 5.
Improved neonatal care for preterm infants has led to an impressive reduction in perinatal preterm infant mortality. Over the last few decades, measures such as maternal antenatal glucocorticoids administration, use of surfactant, and improvement in ventilation strategies have increased survival rates particularly in infants with very low birth weight (VLBW, <1500g) and extremely low birth weight (ELBW, <1000g).
Intrauterine growth is extremely rapid and involves remarkable tissue differentiation. Postnatal adequate nutrition has been shown to be critical to prevent growth failure, optimize long-term growth and to improve long-term outcomes in preterm infants.
In this Module, the current knowledge and recommendations on nutrient requirements for preterm infants are addressed in detail. Additionally, the importance of appropriated nutrition and the clinical practice of nutritional care in preterm infants are discussed, based on the current recommendations derived from an expert panel that included leaders in the field from five continents. The module also includes an overview of preterm birth demographics, causes and consequences.
This module has received accreditation by the German Medical Association with 12 CME credits.
This module has received accreditation by the European Accreditation Council for Continuing Medical Education (EACCME).
Unit 1: The Importance of Optimal Nutrition for Preterm Infants
Each year, an estimated 15 million babies are born prematurely worldwide, before completing 37 weeks of gestation. Although the rates of preterm birth in many countries are increasing, improved conditions of care for premature infants have led to markedly increased survival rates over the last few decades. Therefore, increased attention is now directed to improving their long-term outcome, health and quality of life.
While many factors affecting premature infants – e.g. lower gestational age at birth, smaller size for gestational age, intracranial hemorrhage, white matter damage, infections, and socioeconomic status – are sometimes beyond the control of neonatal intensive care providers, meeting nutritional needs for the preterm infant could be an easier approach that can have a beneficial impact on prognosis and later life.
In this Unit, the definitions and epidemiology of preterm birth are addressed. Additionally, the importance of nutrition for long and short-term health outcomes is discussed with focus on growth, brain and pulmonary development.
Unit 2: Nutritional Requirements of the Preterm Infant
Born too soon, preterm infants lose precious weeks of the normal rapid growth and development that takes place in the last trimester of gestation. They often enter the world too weak to suckle, with an immature gut and immune system. Often they must expend a disproportionate amount of energy to breathe. Most are born at an appropriate weight for gestational age, but by 36 weeks’ postmenstrual age nearly 80% will show growth faltering. Provision of appropriate nutrients in adequate amounts to premature infants is complicated by the frequent need for parenteral nutritional support, issues of nutrient absorption and metabolism, illnesses, and unusually high nutritional requirements to support growth. An understanding of the special nutritional requirements of premature infants as well as available supplements and fortifiers is critical to give these tiny patients the best chances of survival, health and normal growth and development.
In this Unit the special nutritional requirements of infants born prematurely are addressed. Each nutrient will be thoroughly discussed with focus on preterm infant metabolism and requirements.
Unit 3: Nutrition and Feeding Practice in Preterm Infants
This unit addresses the practical aspects of ensuring that preterm infants receive optimal nutritional care after birth. The role of standardized feeding guidelines in enhancing the nutritional care of preterm infants is explained. Practical guidelines for nutritional care are given, including the initiation of parenteral nutrition and the transition to full enteral feeds.
Specific guiding principles in the initiation and maintenance of enteral feeding are thoroughly discussed. Tools and techniques for continuous growth monitoring in the NICU and after discharge is addressed. Also in this unit, the nutritional care of preterm infants in low-resource settings and the optimization of discharge plans for the preterm infant are detailed.