Nutritional Management of the Preterm Infant
Ekhard E. Ziegler, MD
Peer Review Status: Internally Peer Reviewed
Recent years have seen marked changes in the general approach to the nutritional management of preterm infants. The changes reflect a growing awareness of the potential for adverse consequences from starvation and undernutrition during the neonatal period. There can be no doubt that neurodevelopmental processes are susceptible to nutritional insults.
The temporary postnatal growth arrest, which we have come to accept as inevitable, is potentially preventable, if not in its entirety, then at least to a large degree. Somatic growth is a useful indicator of nutritional sufficiency. When somatic growth is near normal, significant nutritional insults to the CNS are unlikely. On the other hand, when somatic growth is abnormal, there is always the possibility of adverse effects on neurodevelopment. Therefore, nutritional efforts aimed at enabling somatic growth as it would have occurred in utero are well justified because they enhance the chance that growth and development of the CNS will continue without interruption.
The trend in recent years has been towards earlier and more aggressive use of parenteral nutrition. This was made possible by expanded use of percutaneously placed central vein catheters. An innovation in enteral feedings has been the use of "trophic" feedings starting very soon after birth. The idea is to prevent intestinal atrophy from occurring, so that, when feedings start in earnest, the gut does not have to go through a lengthy rehabilitation period. Together these two developments have made for greatly improved nutritional management, especially of very small preterm infants.