Pediatric Nutrition in Practice

3 Nutritional Challenges in Special Conditions and Diseases

Key Words

Growth failure · Parenteral nutrition ·

Gastrointestinal priming · Human milk fortification

Key Messages

• Nutrient administration, though technically diffi-
  cult, must be initiated promptly after birth to avoid
  adverse effects of undernutrition


• Because of immaturity of the intestinal tract, the
  use of parenteral nutrition is necessary until feeds
  can be given


• Trophic feeding (gastrointestinal priming) should
  be started promptly and advanced as permitted by
  maturation of intestinal motility


• The preferred feed is breast milk (the mother’s own
  or donated) because of its protective effect against
  sepsis and necrotizing enterocolitis. Formulas for
  preterm infants are the second choice


• Breast milk must be fortified with nutrients to meet
  the high nutrient needs of preterm infants. Fortifi-
  ers raise the nutrient content to adequate levels,
  compensating for shortfalls
  © 2015 S. Karger AG, Basel

Introduction

Postnatal (extrauterine) growth failure is com-

mon among prematurely born infants. It used to

be considered inevitable as well as innocuous. But

it has become clear that far from being inevitable,

it is largely if not exclusively the result of inade-

quate intakes of nutrients. Ehrenkranz et al. [1] ,

among others, have shown in a landmark study

that it is not innocuous. The study established that

growth failure is associated with impairment of

neurocognitive development in a dose-dependent

fashion. The more severe the growth failure, the

more severe is the neurocognitive impairment.

There are mainly two reasons for the occur-

rence of growth failure in premature infants. One

is that there are physiological limitations that

prevent the provision of nutrients in the usual

way, i.e. through enteral feeding. The other rea-

son is that the nutrient needs are exceedingly

high, as summarized in table 1. These needs can-

not be met by human milk alone without nutrient

fortification. Thus, providing nutritional support

to preterm infants presents unique challenges as

failure to provide adequate nutrient intakes at all

stages of development places them at risk of im-

paired neurodevelopment. Every effort must

therefore be made to provide complete nutrition

beginning from birth [2].

Koletzko B, et al. (eds): Pediatric Nutrition in Practice. World Rev Nutr Diet. Basel, Karger, 2015, vol 113, pp 214–217
DOI: 10.1159/000360342

3.14 Preterm and Low-Birth-Weight Infants

Ekhard E. Ziegler