A1 Nutritional aspects in Neonatal Intensive Care Unit
Massimo Agosti, Laura Morlacchi, Francesco Tandoi, Angela Bossi
S.C. Neonatologia, Terapia Intensiva Neonatale e Pediatria Verbano, ASST dei Sette Laghi - Polo universitario, Ospedale "F. Del Ponte", Varese, Italy
Correspondence: Massimo Agosti (massimo.agosti@asst.settelaghi.it)
Neonatologists still face the challenge to provide optimal nutritional care to preterm infants and to limit the postnatal growth failure that preterm infants still experiment [1].
Inadequate parenteral and enteral intakes and the fear of metabolic intolerance lead to a cumulative nutrients’ deficit in early postnatal period [2]. Limiting early malnutrition is of major importance since poor postnatal growth in preterm infants has been associated with impaired neurodevelopmental outcomes [3,4] and altered body composition development [5]. Body composition of preterm infants seems to be characterized by a lack of fat-free mass deposition [6], which, in turns, is determinant for organ growth and development, particularly the brain. Increasing findings actually support an association between postnatal fat-free mass accretion and neurodevelopment [7].
The transition to extrauterine life inevitably contributes to the higher nutritional needs of the preterm infants [5]. It has been demonstrated that the resting energy expenditure of preterm infants increases by 140% in the first six weeks of postnatal age whereas that of term infants increases by 47% [8]. In addition, the major clinical comorbidities that they often experiment (sepsis, neurological impairment, cardiac diseases, surgical complications, administration of medications and the different environmental conditions they are exposed to) necessarily affect infants’ nutritional requirements [9].
The application of standardized nutritional procedures and the attention on individual requirements are of major importance. Several efforts in the last year have been addressed to limit the infants’ postnatal growth restriction: nutritional strategies based on more aggressive parenteral nutrition, adequate weaning from parenteral nutrition and optimization of enteral nutrients administration have been reported to improve growth velocity during hospital stay in neonatal intensive care unit [10,11].
Human milk is the first choice for the nutritional support in preterm infants [12]: its several health benefits on immunological, gastrointestinal and neurodevelopmental functions have been deeply reported. Fortification of human milk is required to meet the high preterm infants’ nutritional requirements [13]. Recent studies suggest that the non-nutritive oral administration of colostrum is safe and it could positively affect development of innate immunity in extremely preterm infants [14].
Oral feeding is the final milestone to achieve for an infant before leaving hospital; as a consequence its implementation is of huge interest. The non-nutritive sucking stimulation, the promotion of human milk use, a cue-based feeding approach and the limitation of the negative experiences the hospitalized infants are expose to, can lead to their earlier achievement of full oral feeding [15].
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