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Nutritional management of the premature infant following discharge from the hospital varies depending on the gestational age or weight at birth, occurrence of postnatal complications that affect nutrition (such as bowel resection for necrotizing enterocolitis), and the need for specialized nutritional supplementation due to an inability to take adequate calories orally or due to the risk of oral feeding. Feeding issues are discussed in Chapter 31, and specialized nutritional support is discussed in Chapter 33. Details of nutritional support prior to discharge from the nursery are discussed in Chapters 43 and 45. This chapter discusses the special nutritional needs of infants with a birth weight of less than 2.5 kg following discharge from the nursery.


A widely accepted nutritional goal for the preterm infant is for growth and body composition of the premature infant to reflect that of a fetus of comparable postconceptional age. In practice, this is a difficult target to achieve because of problems encountered with the administration of adequate caloric feedings by either the intravenous or enteral route in the stressed premature infant. Despite efforts to promote growth during hospitalization, preterm infants usually accrue significant nutrient deficits during hospitalization, and at the time of discharge, most preterm infants born at weights less than 1500 g (very low birth weight) have moderate to severe growth failure. Infants with significant morbidities and infants born at less than 1000 g (extremely low birth weight) have more severe growth failure because they regain birth weight at a later age, and they gain weight more slowly.


Assessment of growth requires the use of specialized growth curves developed specifically to monitor the growth of premature infants.1,2 Term infants lose on average 5% to 7% of their birth weight during the first 3 to 4 days of life, regaining birth weight by days 7 to 10. In contrast, premature infants lose up to 15% of their birth weight over the first 10 days of life. In general, babies born between 24 and 29 weeks gestation do not regain birth weight until about 2.5 weeks after birth. When compared to expected in utero growth, these infants generally reach the 10th percentile by 32 weeks gestational age and continue to grow along or below the 10th percentile through discharge. Monitoring the adequacy of nutrition following discharge is important to assure optimal catch-up growth.


Cumulative energy and protein deficits accrue at 1 and 6 weeks age in infants born at 31 weeks’ gestation or earlier.3 These deficits tend to worsen when infants are fed a formula designed for healthy full-term infants or if they are fed with unsupplemented breast milk at discharge. Bone mineral content is usually decreased in premature infants after discharged from the hospital,4-6 so attention to calcium, phosphorus, and vitamin D intake is also critical to catch up bone mass accretion.7,8 The options, postdischarge, for feeding infants born at less than ...

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