TY - CHAP M1 - Book, Section TI - Nutrition and Growth A1 - Malcolm, William F. PY - 2015 T2 - Beyond the NICU: Comprehensive Care of the High-Risk Infant AB - Early nutrition for the very low birthweight infant (VLBW)Nutritional strategies for VLBW infants should minimize the interruption of growth and development as the fetus transitions to extrauterine life.The initial phase of management with total parenteral nutrition (TPN) improves growth byReducing postnatal weight lossPromoting earlier return to birthweight (RTBW)Facilitating catch-up growthWhen TPN is used exclusively for the provision of nutrients with no enteral nutrition, morphologic and functional changes occur in the gut includingSignificant decrease in intestinal massDecrease in mucosal enzyme activityIncrease in gut permeabilityThe changes are due primarily to the lack of luminal nutrients.The earlier initiation of enteral feedings has direct trophic effects on the gastrointestinal tract and indirect effects secondary to release of intestinal hormones.Initiation of TPN with early enteral feedings the first days of life allows feedings to be advanced slowly, which may increase the tolerance and safety of enteral feedings.Postnatal growth failureMany VLBW infants experience extrauterine growth restriction (EUGR).Figure 11-1 is based on data from the National Institutes of Child Health and Human Development (NICHD) Neonatal Research Network demonstrating the differences between normal intrauterine growth and the postnatal growth failure among the VLBW infants in the NICHD study.This “growth faltering” is most common among extremely low birthweight infants (ELBW) (birthweight 70, and were less likely to demonstrate abnormal neurologic findings at 18 to 22 months corrected age. The lowest growth quartile (12 g/kg/d and 0.67 cm/wk), respectively, had the highest risk for morbidity; therefore, inadequate nutrition is responsible for the poor outcomes observed here.These studies emphasize the importance of closely monitoring nutritional intake and growth inhospital for VLBW infants.Because weight gain and head circumference growth are associated with better neurodevelopmental and growth outcomes at 18 to 22 months corrected age, goals of growth ... SN - PB - McGraw-Hill Education CY - New York, NY Y2 - 2024/11/03 UR - accesspediatrics.mhmedical.com/content.aspx?aid=1105545094 ER -