Early and Aggressive Nutritional Strategy in the Very Low Birth Weight Premature Infants: Preventing Extrauterine Growth Restriction

Survival of premature newborn has increased, particularly among VLBW infants, mostly due to improved knowledge and technologies in neonatal intensive care. Optimal nutritional support for these high-risk premature infants still remains controversial. There is inadequate evidence to define which strategies ensure adequate growth to optimize neurodevelopmental outcome and prevent cardiovascular or metabolic diseases in adulthood. The American Academy of Pediatrics Committee on Nutrition (1985) sets as a “gold standard” a prompt postnatal resumption of growth to a rate-approximating intrauterine growth because this is believed to provide the best possible conditions for subsequent normal development. An additional aim is to mimic body composition of the age-matched fetus. Current nutritional support received by preterm infants may not prevent EUGR, defined as body weight and length below the 10th percentile expected for fetuses of the same PMA. No evidence justifies the interruption of nutrient support after birth. To prevent catabolism due to nutritional deprivation from the first day of life, VLBW infants should receive appropriate energy and proteins during the transition period from fetal to neonatal life. Current recommendations are to provide early and more aggressive nutritional intake. This practice has resulted in a shorter time to regain birth weight and fewer infants with EUGR. In this chapter, we will review the requirements of energy and protein to prevent deficiencies, recommendations about what is optimal nutrition, and when is the best time to initiate nutritional support for this high-risk population.