Special circumstances: trophic feeds, necrotizing enterocolitis and bronchopulmonary dysplasia.
There are many unresolved issues regarding how to feed the extremely-low-birth-weight (ELBW) infant. Trophic feedings of small volumes of breast milk or formula do not appear to increase the incidence of necrotizing enterocolitis (NEC). For prevention of NEC, breast milk, antenatal steroids and fluid restriction each confers a benefit. Because the incidence of NEC is relatively low, to determine if a particular prevention strategy is effective, large numbers of infants would need to be enrolled in a prospective, randomized controlled trial, and such trials are rare. Candidate therapies for NEC prevention that warrant further study include oral immunoglobulins, probiotics, long-chain polyunsaturated fatty acids and arginine. Suboptimal nutrition in ELBW infants is common in the early postnatal period. This is also the most critical time for the development of bronchopulmonary dysplasia, when even brief periods of malnutrition have significant effects on lung development and growth.
Reynolds
Regina M
RM
University of Colorado Health Sciences Center, The Children's Hospital, 4200 E. 9th Avenue, B-195, Denver, CO 80262, USA. regina.reynolds@uchsc.edu
Thureen
Patti J
PJ
D001997:Bronchopulmonary Dysplasia / Q000517:prevention & control*; D004750:Enteral Nutrition; D020345:Enterocolitis, Necrotizing / Q000517:prevention & control*; D006801:Humans; D007225:Infant Food; D007227:Infant Nutritional Physiological Phenomena; D007231:Infant, Newborn; D019102:Infant, Very Low Birth Weight; D008895:Milk, Human; D009751:Nutritional Requirements; D010288:Parenteral Nutrition; D016032:Randomized Controlled Trials as Topic