Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Article
  • Published:

Pragmatic Approach to In-Hospital Nutrition in High-Risk Neonates

Journal of Perinatology volume 25, pages S7–S11 (2005)Cite this article

Abstract

Extremely low birth weight infants may experience periods of moderate to severe undernutrition during the acute phase of their respiratory problems. This undernutrition contributes to early growth deficits in these patients and may have long-lasting effects, including poor neurodevelopmental outcome. Early postnatal intravenous amino-acid administration and early enteral feeding strategies will minimize the interruption of nutrient intake that occurs with premature birth. These two strategies will prevent intracellular energy failure, allow the administration of more non-protein energy, as well as enhance overall nutritional health, as evidenced by less postnatal weight loss and earlier return to birth weight, and improved overall postnatal growth and outcome.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Figure 1

Similar content being viewed by others

References

  1. Ehrenkranz RA, Younes N, Lemons JA, et al. Longitudinal growth of hospitalized very-low-birth-weight infants. Pediatrics 1999;104:280–289.

    Article  CAS  Google Scholar 

  2. Carlson SJ, Ziegler EE . Nutrient intakes and growth of very-low-birth-weight infants. J Perinatol 1998;18:252–258.

    CAS  Google Scholar 

  3. Embleton NE, Pang N, Cooke RJ . Postnatal malnutrition and growth retardation: an inevitable consequence of current recommendations in preterm infants? Pediatrics 2001;107:270–273.

    Article  CAS  Google Scholar 

  4. Hay Jr WW, Lucas A, Heird WC, et al. Workshop summary: nutrition of the extremely-low-birth-weight infant. Pediatrics 1999;104:1360–1368.

    Article  Google Scholar 

  5. Frantz ID, L'Heureux P, Engel RR . Necrotizing enterocolitis. J Pediatr 1975;86:259.

    Article  Google Scholar 

  6. Kliegman RM, Fanaroff AA . Neonatal necrotizing enterocolitis: a nine-year experience. Am J Dis Child 1981;135:603–607.

    Article  CAS  Google Scholar 

  7. Johnson JD, Albritton WL, Sunshine P . Hyperammonemia accompanying parenteral nutrition in newborn infants. J Pediatr 1972;81 (1):154–161.

    Article  CAS  Google Scholar 

  8. Kashyap S, Heird W . Protein requirements of low-birth-weight, very-low birth-weight, and small-for-gestational-age infants. In: Raiha N, editor. Protein Metabolism During Infancy. New York: Raven Press; 1993. p. 133–151.

    Google Scholar 

  9. Rubecz I, Mestyan J, Varga P, Klujber L . Energy metabolism, substrate utilization, and nitrogen balance in parenterally fed postoperative neonates and infants. The effect of glucose, glucose + amino acids, lipid + amino acids infused in isocaloric amounts. J Pediatr 1981;98 (1):42–46.

    Article  CAS  Google Scholar 

  10. Zlotkin SH, Bryan MH, Anderson GH . Intravenous nitrogen and energy intakes required to duplicate in utero nitrogen accretion in prematurely born human infants. J Pediatr 1981;99 (1):115–120.

    Article  CAS  Google Scholar 

  11. Duffy B, Gunn T, Collinge J, Pencharz P . The effect of varying protein quality and energy intake on the nitrogen metabolism of parenterally-fed very- low-birth-weight (less than 1600 g) infants. Pediatr Res 1981;15 (7):1040–1044.

    Article  CAS  Google Scholar 

  12. Van Toledo-Eppinga L, Kalhan SC, Kulik W, Jakobs C, Lafeber HN . Relative kinetics of phenylalanine and leucine in low-birth-weight infants during nutrient administration. Pediatr Res 1996;40 (1):41–46.

    Article  CAS  Google Scholar 

  13. Anderson TL, Muttart CR, Bieber MA, Nicholson JF, Heird WC . A controlled trial of glucose versus glucose and amino acids in premature infants. J Pediatr 1979;94 (6):947–951.

    Article  CAS  Google Scholar 

  14. Yu VY, James B, Hendry P, MacMahon RA . Total parenteral nutrition in very-low-birth-weight infants: a controlled trial. Arch Dis Child 1979;54 (9):653–661.

    Article  CAS  Google Scholar 

  15. Saini J, MacMahon P, Morgan JB, Kovar IZ . Early parenteral feeding of amino acids. Arch Dis Child 1989;64 (10 Spec No):1362–1366.

    Article  CAS  Google Scholar 

  16. Van Lingen RA, Van Goudoever JB, Luijendijk IH, Wattimena JL, Sauer PJ . Effects of early amino acid administration during total parenteral nutrition on protein metabolism in pre-term infants. Clin Sci (Lond) 1982;82 (2):199–203.

    Article  Google Scholar 

  17. Van Goudoever JB, Colen T, Wattimena JL, Huijmans JG, Carnielli VP, Sauer PJ . Immediate commencement of amino acid supplementation in preterm infants: effects on serum amino acid concentrations and protein kinetics on the first day of life. J Pediatr 1995;127 (3):458–465.

    Article  CAS  Google Scholar 

  18. Thureen PJ, Anderson AH, Baron KA, Melara DL, Hay Jr WW, Frennessey PV . Protein balance in the first week of life in ventilated neonates receiving parenteral nutrition. Am J Clin Nutr 1998;68 (5):1128–1135.

    Article  CAS  Google Scholar 

  19. Rivera Jr A, Bell EF, Bier DM . Effect of intravenous amino acids on protein metabolism of preterm infants during the first three days of life. Pediatr Res 1993;33 (2):106–111.

    Article  Google Scholar 

  20. Thureen PJ, Hay WW . Intravenous nutrition and postnatal growth of the micro preemie. Clin Perinatal 2000;27 (1):225–244.

    Article  Google Scholar 

  21. Heird WC, Jensen CL, Gomez MR . Practical aspects of achieving positive energy balance in low-birth-weight infants. J Pediatr 1992;120:120–128.

    Article  Google Scholar 

  22. Lucas A . Minimal enteral feeding. Seminars in neonatal nutrition and metabolism. 1993;1:2.

    Google Scholar 

  23. Dworkin LD, Levine GM, Farber NJ, et al. Small intestinal mass of the rat is partially determined by indiscrete effects intraluminal nutrition. Gastroenterology 1976;71:626–630.

    CAS  PubMed  Google Scholar 

  24. Levine GM, Deren JJ, Steiger E, Zinner R . Role of oral intake in maintenance of gut mass and disaccharide activity. Gastroenterology 1974;67:975–982.

    CAS  PubMed  Google Scholar 

  25. Lucas A, Bloom SR, Aynsley-Green A . Gut hormones and “minimal enteral feeding”. Acta Pediatr Scand 1986;75:719–723.

    Article  CAS  Google Scholar 

  26. Kliegman RM . Experimental validation of neonatal feeding practices. Pediatrics 1999;103:492–493.

    Article  CAS  Google Scholar 

  27. Ziegler EE . Trophic Feeds. In: Ziegler EE, Lucas A, Moro GE, editors. Nutrition of the Very-Low-Birth-Weight Infant. Vevey: Lippincott Williams and Wilkins;1999. p. 233–244.

    Google Scholar 

  28. Mihatsch WA, von Schoenaich P, Fahnenstich H, Dehne N, Ebbecke H, Plath C . The significance of gastric residuals in the early enteral feeding advancement of extremely-low-birth-weight infants. Pediatrics 2002;109:457–459.

    Article  Google Scholar 

  29. Kleigman RM . Commentary studies of feeding intolerance in very-low-birth-weight infants: definitive and significance. Pediatrics 2002;109 (3):671–672.

    Google Scholar 

  30. Brown EG, Sweet AY . Preventing necrotizing enterocolitis in neonates. JAMA 1978;240:2452–2454.

    Article  CAS  Google Scholar 

  31. Tyson JE, Kennedy K . Minimal enteral nutrition in parenterally fed neonates. 1997. Available at: http://www.nichd.nih.gov/cochraneneonatal/tyson/tyson/htm.

  32. McClure RJ, Newell SJ . Randomized control study of clinical outcome following trophic feeding. Arch Dis Child Fetal Neonatal Ed 2000;82:F29–F33.

    Article  CAS  Google Scholar 

  33. Anderson DM, Kliegman RM . The relationship of neonatal alimentation practices to the occurrence of endemic necrotizing enterocolitis. Am J Perinatol 1991;8:62–67.

    Article  CAS  Google Scholar 

  34. Rayyis SF, Ambalavanan N, Wright L, Carlo WA . Randomized trial of “slow” versus “fast” feed advancements on the incidence of necrotizing enterocolitis in very-low-birth-weight infants. J Pediatr 1999;134:293–297.

    Article  CAS  Google Scholar 

  35. Caeton AJ, Goetzman BW . Risk business, umbilical arterial catheterization. Am J Dis Child 1985;139:120.

    Article  CAS  Google Scholar 

  36. Davey AM, Wagner CL, Phelps DL, et al. Do premature infants with umbilical artery catheters tolerate oral feeds? Pediatr Res 199A;31:199A.

    Google Scholar 

  37. Kerner JA . The use of umbilical catheters for parenteral nutrition. In: Kerner JA editor. Manual of Pediatric Parenteral Nutrition. New York: John Wiley & Sons; 1993. p. 303.

    Google Scholar 

  38. Wesstrom G, Finnstrom O, Stenport G . Umbilical artery catheterization in newborns: I. Thrombosis in relation to catheter type and position. Acta Pediatr Scand 1979;68:575.

    Article  CAS  Google Scholar 

  39. Lucas A, Cole TJ . Breast milk and neonatal necrotizing enterocolitis. Lancet 1990;336:1519–1523.

    Article  CAS  Google Scholar 

  40. Berseth CL, Bisquera JA, Page U . Prolonging small feeding volumes early in life decreases incidence of NEC in very-low-birth-weight infants. Pediatrics 2003;111 (3):529–533.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Neonatal Medicine, University of Louisville, Louisville, KY, USA

    David H Adamkin MD

Authors
  1. David H Adamkin MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Additional information

Disclosure: No significant relationship to disclose.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Adamkin, D. Pragmatic Approach to In-Hospital Nutrition in High-Risk Neonates. J Perinatol 25 (Suppl 2), S7–S11 (2005). https://doi.org/10.1038/sj.jp.7211309

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/sj.jp.7211309

This article is cited by

Search

Advanced search

Quick links