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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.
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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.
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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.
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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 ...