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01-12-2013 | Neonatology (F Greer, Section Editor)

Aggressive Nutrition of the Preterm Infant

Author: William W. Hay Jr.

Published in: Current Pediatrics Reports | Issue 4/2013

Abstract

Nutrition of preterm infants should result in growth similar to that of normally growing fetuses of the same gestational age. Unfortunately, most preterm infants are not fed enough to achieve this objective; as a result they are growth restricted by term gestation. Recent studies have demonstrated that early and enhanced “aggressive” nutrition of preterm infants can reduce postnatal growth failure and improve longer-term outcomes, particularly for the brain and its cognitive functions. When preterm infants are fed more aggressively (earlier onset of intravenous and enteral feeding, earlier achievement of full enteral feeding) cumulative energy and protein deficits are reduced and they consistently regain birth weight sooner, the incidence of necrotizing enterocolitis and late-onset sepsis is unchanged or reduced, and they achieve discharge criteria and go home sooner, with overall shorter hospital stays, and have improved anthropometrics by term gestation. More research is needed, however, to determine optimum feeding of preterm infants, particularly during periods of illness and physiological instability.

American Academy of Nutrition Committee on Nutrition. Nutritional needs of low-birth-weight infants. Pediatrics. 1977;60:519–30.

Higgins RD, Devaskar S, Hay WW Jr, et al. Executive summary of the workshop “Nutritional Challenges in the High Risk Infant”. J Pediatr. 2012;160:511–6.PubMedCrossRef

Ehrenkranz RA, Younes N, Lemons JA, et al. Longitudinal growth of hospitalized very low birthweight infants. Pediatrics. 1999;104:280–9.PubMedCrossRef

•• Ehrenkranz RA, Das A, Wrage LA, et al., Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network. Early nutrition mediates the influence of severity of illness on extremely LBW infants. Pediatr Res. 2011;69:522–9. This article makes the important point that preterm infants often are not fed because they are sick and/or physiologically unstable. Thus, it remains uncertain how much of postnatal growth failure is a result of adverse effects of illness, or underfeeding, or both.

Wahlig TM, Georgieff MK. The effects of illness on neonatal metabolism and nutritional management. Clin Perinatol. 1995;22:77–96.PubMed

Wahlig TM, Gatto CW, Boros SJ, et al. Metabolic response of preterm infants to variable degrees of respiratory illness. J Pediatr. 1994;124:283–8.PubMedCrossRef

Stockman JA III, Clark DA. Weight gain: a response to transfusion in selected preterm infants. Am J Dis Child. 1984;138:828–30.PubMed

• Bose CL, Laughon MM, Allred EN, et al., ELGAN Study Investigators. Systemic inflammation associated with mechanical ventilation among extremely preterm infants. Cytokine. 2013;61:315–22. This article illustrates the increasingly recognized problem of systemic inflammation that occurs in preterm infants as a result of diseases and their treatment. Systemic inflammation from any cause produces cytokines and catabolic hormones that limit growth and must be taken into account when trying to improve the nourishment and growth of sick infants.

Torrazza RM, Neu J. The altered gut microbiome and necrotizing enterocolitis. Clin Perinatol. 2013;40:93–108.PubMedCrossRef

10.

•• Morgan C. Early amino acid administration in very preterm infants: too little, too late or too much, too soon? Semin Fetal Neonatal Med. 2013. doi:10.1016/j.siny.2013.02.002. This excellent review focuses on the value of early amino acid administration to enhance protein gain and growth and particularly neurological development, but also documents risks associated with excess amino acids. It also provides references to support the value of developing consistent nutritional practices (guidelines or protocols) to ensure nutrition is safely and effectively managed, which seems to promote better nutrition and growth and is a much more consistent way of assessing outcomes.

11.

Koletzko B, Goulet O, Hunt J, et al. Guidelines on paediatric parenteral nutrition. JPGN. 2005;41(Suppl 2):S1–87.PubMed

12.

Mavaheer A, Grime C, Morgan C. Increased early protein intake is associated with a reduction in insulin-treated hyperglycaemia in very preterm infants. Nutr Clin Pract. 2012;27:399–405.CrossRef

13.

Morgan C, Herwitker S, Badhawi I, et al. SCAMP: Standardised, Concentrated, Additional Macronutrients, Parenteral nutrition in very preterm infants: a phase IV randomised, controlled exploratory study of macronutrient intake, growth and other aspects of neonatal care. BMC Pediatr. 2011;11:53–64.PubMedCrossRef

14.

Morgan C, McGowan P, Herwitker S, et al. Preventing early postnatal head growth failure in very preterm infants: the randomised controlled SCAMP nutrition study. Arch Dis Child Fetal Neonatal Ed. (in press).

15.

Dinerstein A, Neito RM, Solana CL, et al. Early and aggressive nutritional strategy (parenteral and enteral) decreases postnatal growth failure in very low birth weight infants. J Perinatol. 2006;26:436–42.PubMedCrossRef

16.

Embleton NE, Pang N, Cooke RJ. Postnatal malnutrition and growth retardation: an inevitable consequence of current recommendations in preterm infants? Pediatrics. 2001;107:270–3.PubMedCrossRef

17.

Barker DJP, Eriksson JG, Forsén T, et al. Fetal origins of adult disease: strength of effects and biological basis. Int J Epidemiol. 2002;31:1235–9.PubMedCrossRef

18.

Lucas A. Programming by early nutrition in man. CIBA Found Symp. 1991;156:38–50.PubMed

19.

Carmody JB, Charlton JR. Short term gestation, long term risk: prematurity and chronic kidney disease. Pediatrics. 2013;131:1168–79.PubMedCrossRef

20.

Isaacs EB, Gadian DG, Sabatini S, et al. The effect of early human diet on caudate volumes and IQ. Pediatr Res. 2008;63:308–14.PubMedCrossRef

21.

Parish A, Bhatia J. Early aggressive nutrition for the premature infant. Neonatology. 2008;94:211–4.PubMedCrossRef

22.

Ziegler EE, Thureen PJ, Carlson SJ. Aggressive nutrition of the very low birthweight infant. Clin Perinatol. 2002;29:225–44.PubMedCrossRef

23.

Thureen PJ, Hay WW Jr. Early aggressive nutrition in preterm infants. Semin Neonatol. 2001;6:403–15.PubMedCrossRef

24.

Ehrenkranz RA. Early, aggressive nutritional management for very low birth weight infants: what is the evidence? Semin Perinatol. 2007;31:48–55.PubMedCrossRef

25.

Vlaardingerbroek H, van Goudoever JB, van den Akker CH. Initial nutritional management of the preterm infant. Early Hum Dev. 2009;85:691–5.PubMedCrossRef

26.

De Curtis M, Rigo J. The nutrition of preterm infants. Early Human Dev. 2012;88(Suppl 1):S5–7.CrossRef

27.

Hay WW Jr, Thureen PJ. Early postnatal administration of intravenous amino acids to preterm, extremely low birth weight infants. J Pediatr. 2006;148:291–4.PubMedCrossRef

28.

Thureen PJ, Melara D, Fennessey PV, Hay WW Jr. Effect of low versus high intravenous amino acid intake on very low birth weight infants in the early neonatal period. Pediatr Res. 2003;53:24–32.PubMedCrossRef

29.

• Senterre T, Rigo J. Reduction in postnatal cumulative nutritional deficit and improvement of growth in extremely preterm infants. Acta Paediatr. 2012;101:e64–70. This review article documents with excellent evidence the benefits of enhancing early nutrition in preterm infants.

30.

Reynolds RM, Bass KD, Thureen PJ. Achieving positive protein balance in the immediate postoperative period in neonates undergoing abdominal surgery. J Pediatr. 2008;152:63–7.PubMedCrossRef

31.

van den Akker CH, Vlaardingerbroek H, van Goudoever JB. Nutritional support for extremely low-birth weight infants: abandoning catabolism in the neonatal intensive care unit. Curr Opin Clin Nutr Metab Care. 2010;13:327–35.PubMedCrossRef

32.

Maggio L, Cota F, Gallini F, et al. Effects of high versus standard early protein intake on growth of extremely low birth weight infants. JPGN. 2007;44:124–9.PubMed

33.

Radmacher PG, Lewis SL, Adamkin DH. Early amino acids and the metabolic response of ELBW infants (<or =1000 g) in three time periods. J Perinatol. 2009;29:433–7.PubMedCrossRef

34.

Valentine CJ, Fernandez S, Rogers LK, et al. Early amino-acid administration improves preterm infant weight. J Perinatol. 2009;29:428–32.PubMedCrossRef

35.

Hanson C, Sundermeier J, Dugick L, et al. Implementation, process, and outcomes of nutrition best practices for infants <1500 g. Nutr Clin Pract. 2011;26:614–24.PubMedCrossRef

36.

Collins CT, Chua MC, Rajadurai VS, et al. Higher protein and energy intake is associated with increased weight gain in pre-term infants. J Paediatr Child Health. 2010;46:96–102.PubMedCrossRef

37.

• Moyses HE, Johnson MJ, Leaf AA, et al. Early parenteral nutrition and growth outcomes in preterm infants: a systematic review and meta-analysis. Am J Clin Nutr. 2013;97:816–26. This article is an up to date review of the value of early parenteral nutrition to promoting growth. It provides a balanced perspective from an extensive literature review and, most importantly, a critical appraisal of the literature using a meta-analysis approach.

38.

Can E, Bülbül A, Uslu S, et al. Effects of aggressive parenteral nutrition on growth and clinical outcome in preterm infants. Pediatr Int. 2012;54:869–74.PubMedCrossRef

39.

Wang C, Han LY, Zhang LJ, et al. Effect of aggressive nutritional support on preterm infants during hospitalization. Zhonghua Er Ke Za Zhi. 2011;49:771–5.PubMed

40.

• Burattini I, Bellagamba MP, Spagnoli C, et al. 2.5 vs 4 grams/kg/day of amino acids to extremely low birth weight infants on parenteral nutrition: a randomized clinical trial. J Pediatr. 2013 (in press). This article provides novel research data to show that higher protein intake from parenteral amino acids in the first week of life does reduce glucose concentrations but is not associated with longer-term growth advantage. The latter observation raises the questions—what does promote longer term growth and how should nutrition of preterm infants in the NICU be modified to promote growth?

41.

Loqvist C, Engstrom E, Sighurdsson J, et al. Postnatal head growth deficit among premature infants parallels retinopathy of prematurity and insulin-like growth factor-1 deficit. Pediatrics. 2006;117:1930–8.CrossRef

42.

•• Hansen-Pupp I, Hovel H, Hellstrom A, et al. Postnatal decrease in circulating insulin-like growth factor-1 and low brain volumes in very preterm infants. J Clin Endocrinol Metab. 2011;96:1129–35. This research article provides important data that indicate how undernutrition of preterm infants can reduce anabolic growth factors, for example IGF-1, which then leads to poor growth of not only the less vital organs but also, unfortunately, the brain .

43.

Clark RH, Chace DH, Spitzer AR. Effects of two different doses of amino acid supplementation on growth and blood amino acid levels in premature neonates admitted to the neonatal intensive care unit: a randomized, controlled trial. Pediatrics. 2007;120:1286–96.PubMedCrossRef

44.

Poindexter BB, Langer JC, Dusick AM, et al., for the NICHD Neonatal Research Network. Early provision of parenteral amino acids in extremely low birth weight infants: Relation to growth and neurodevelopmental outcome. J Pediatr. 2006;148:300–5.

45.

•• Scattolin S, Gaio P, Betto M, et al. Parenteral amino acid intakes: possible influences of higher intakes on growth and bone status in preterm infants. J Perinatol. 2013;33:33–9. This important study showed that early higher amino acid intake improved growth without short-term amino acid intolerance, but specifically that greater amino acid intake was associated with greater lower leg length (and thus overall length), which also correlated well with bone status measured by metacarpus bone transmission time (mcBTT). This study supports other observations that indicate that better nutrition of preterm infants, with higher protein intake, has the potential to prevent later life stunting.

46.

• Blanco CL, Gong AK, Schoolfield J, et al. Impact of early and high amino acid supplementation on ELBW infants at 2 years. JPGN. 2012;54:601–7. This article provides provocative data indicating that some sick infants can develop quite high levels of specific amino acids and levels of blood urea nitrogen, perhaps related to their degree of illness, hydration status, renal function, or other problems with physiological instability, or to a less than optimum mix of amino acids in the TPN solution. This articles differs from nearly all others in suggesting there might be potential adverse growth and development consequences of early, aggressive TPN in preterm infants and that further research into how to optimize TPN solutions for sicker infants is very much needed.

47.

Blanco CL, Falck A, Green BK, et al. Metabolic responses to early and high protein supplementation in a randomized trial evaluating the prevention of hyperkalemia in extremely low birth weight infants. J Pediatr. 2008;153:535–40.PubMedCrossRef

48.

Batshaw ML, Wachtel RC, Thomas GH, et al. Arginine-responsive asymptomatic hyperammonemia in the premature infant. J Pediatr. 1984;105:86–91.PubMedCrossRef

49.

Greer F. Early high-dose amino acids for ELBW infants: too early and too much? JPGN. 2012;54:576.PubMed

50.

Zamora SA, Amin HJ, McMillan DD, et al. Plasma l-arginine concentrations in premature infants with necrotising enterocolitis. J Pediatr. 1997;131:226–32.PubMedCrossRef

51.

Amin H, Zamora S, McMillan D, et al. Arginine supplementation prevents necrotizing enterocolitis in the premature infant. J Pediatr. 2002;140:425–31.PubMedCrossRef

52.

Poindexter BB, Ehrenkranz RA, Stoll BJ, et al. Parenteral glutamine supplementation does not reduce the risk of mortality or late-onset sepsis in extremely low birth weight infants. Pediatrics. 2004;113:1209–15.PubMedCrossRef

53.

• Brown LD, Rozance PJ, Thorn SR, et al. Acute supplementation of amino acids increases net fetal protein accretion in IUGR fetal sheep. Am J Physiol Endocrinol Metab. 2012;303:E352–64. This basic science article is important for showing there are unique metabolic responses to supplemental amino acids by growth-restricted fetuses, but insulin does not play a significant role. If applicable to preterm infants of the same gestational age who had IUGR along with postnatal growth restriction, this article provides valuable information about the importance of maintaining normal supplies of amino acids for these special infants.

54.

Ridout E, Melara D, Rottinghaus S, et al. Blood urea nitrogen concentration as a marker of amino-acid intolerance in neonates with birthweight less than 1250 g. J Perinatol. 2005;25:130–3.PubMedCrossRef

55.

Burgess L, Morgan C, Mayes K, et al. Plasma arginine levels and blood glucose control in very preterm infants receiving 2 different parenteral nutrition regimens. J Parenter Enter Nutr. 2013. doi:10.1177/0148607113479130.

56.

Vlaardingerbroek H, Vermeulen MJ, Rook D, et al. Safety and efficacy of early parenteral lipid and high-dose amino acid administration to very low birth weight infants. J Pediatr. 2013. doi:10.1016/j.jpeds.2013.03.059.

57.

Ponté C, Gaudier B, Deconinck B, et al. Blood glucose, serum insulin and growth hormone response to intravenous administration of arginine in premature infants. Biol Neonate. 1972;20:262–9.PubMedCrossRef

58.

Wu G, Jaegar LA, Bazar FW, et al. Arginine deficiency in preterm infants: biochemical mechanisms and nutritional implications. J Nutr Biochem. 2004;15:442–51.PubMedCrossRef

59.

Jadhav P, Parimi PS, Kalhan SC. Parenteral amino acid and metabolic acidosis in premature infants. J Parenter Enter Nutr. 2007;31:278–83.CrossRef

60.

Neu J. In: Fanaroff AA, Benitz WE, Donn SM, Neu J, Papile L, editors. Commentary in 2012 year book of neonatal and perinatal medicine. Philadelphia: Elsevier; 2012. p. 216–9.

61.

Kashyap S, Ohira-Kist K, Abildskov K, et al. Effects of quality of energy intake on growth and metabolic response of enterally fed low-birth-weight infants. Pediatr Res. 2001;50:390–7.PubMedCrossRef

62.

Kashyap S, Schulze KF. Energy requirements and protein–energy metabolism and balance in preterm and term infants. In: Thureen PJ, Hay Jr WW, editors. Neonatal nutrition and metabolism. 2nd ed. Cambridge: Cambridge University Press; 2006. p. 134–46.CrossRef

63.

Brown LD, Hay WW Jr. Effect of hyperinsulinemia on amino acid utilization and oxidation independent of glucose metabolism in the ovine fetus. Am J Physiol Endocrinol Metab. 2006;291:E1333–40.PubMedCrossRef

64.

Ogilvy-Stuart A, Beardsall K. Management of hyperglycaemia in the preterm infant. Arch Dis Child Fetal Neonatal Ed. 2010;95:F126–31.PubMedCrossRef

65.

Hays SP, Smith EO, Sunehag AL. Hyperglycaemia is a risk factor for early death and morbidity in extremely low birthweight infants. Pediatrics. 2006;118:1811–9.PubMedCrossRef

66.

• Van der Lugt NM, Smits-Wintjens VEHJ, van Zweiten PHT, et al. Short and long term outcome of neonatal hyperglycaemia in very preterm infants: a retrospective follow-up study. BMC Pediatr. 2010;10:52–8. Though limited by being retrospective, this article provides important information about the adverse effects of hyperglycemia on preterm infants, which is increasingly seen as a significant adverse condition among these infants that should be prevented before it leads to complex and risky treatment.

67.

Ibrahim HM, Jeroudi MA, Baier RJ, et al. Aggressive early total parental nutrition in low-birth-weight infants. J Perinatol. 2004;24:482–6.PubMedCrossRef

68.

Sauerwald UC, Fink MM, Demmelmair H, et al. Effect of different levels of docosahexaenoic acid supply on fatty acid status and linoleic and α-linolenic acid conversion in preterm infants. JPGN. 2012;54:353–63.PubMed

69.

•• Lapillonne A, Eleni dit Trolli S, Kermorvant-Duchemin E. Postnatal docosahexaenoic acid deficiency is an inevitable consequence of current recommendations and practice in preterm infants. Neonatology. 2010;98:397–403. This article provides unique and disturbing data showing that, as with cumulative protein and energy deficits from underfeeding, cumulative deficits of the essential polyunsaturated fatty acid, docosahexaenoic acid, also occur and have the potential to limit neurodevelopment.

70.

Neu J, Bradley CL, Ding ZY, et al. Feeding the preterm infant: opportunities and challenges of bringing science to the bedside. J Pediatr. 2013;162(3 Suppl):S101–6.PubMedCrossRef

71.

Tyson JE, Kennedy KA. Trophic feedings for parenterally fed infants. Cochrane Database Syst Rev. 2005;3. Review.

72.

Kennedy KA, Tyson JE. Early versus delayed initiation of progressive enteral feedings for parenterally fed low birth weight or preterm infants. Cochrane Database Syst Rev. 2004;4. Review.

73.

Kennedy KA, Tyson JE. Rapid versus slow rate of advancement of feedings for promoting growth and preventing necrotizing enterocolitis in parenterally fed low-birth-weight infants. Cochrane Database Syst Rev. 2005;2. Review.

74.

•• Murgas Torrazza R, Neu J. The developing intestinal microbiome and its relationship to health and disease in the neonate. J Perinatol. 2011;31(Suppl 1):S29–34. This review article is an excellent resource for understanding the effect of the intestinal microbiome on the health of preterm infants. Increasingly, it is recognized that the microbiome of the preterm infant is altered dramatically from that in normal infants, on the basis of abnormal maternal flora, use of antibiotics for both mother and infant, enteral diets that do not include normal flora and often initiate growth of unhealthy flora, and more.

75.

Indrio F, Neu J. The intestinal microbiome of infants and the use of probiotics. Curr Opin Pediatr. 2011;23:145–50.PubMedCrossRef

76.

The SIFT Investigators Group [Abbott J, Berrington JE, Boyle E, Dorling JS, Embleton NE, Juszczak E, Leaf AA, Linsell L, Johnson S, McCormick K, McGuire W, Roberts T, Stenson B]. Early enteral feeding strategies for very preterm infants: current evidence from Cochrane reviews. Arch Dis Child Fetal Neonatal Ed. 2013. doi:10.1136/archdischild-2012-303260.

77.

Ghandehari H, Lee ML, Rechtman DJ, H2MF Study Group. An exclusive human milk-based diet in extremely premature infants reduces the probability of remaining on total parenteral nutrition: a reanalysis of the data. BMC Res Notes. 2012;5:188.PubMedCrossRef

78.

Schanler RJ, Lau C, Hurst NM, et al. Randomized trial of donor human milk versus preterm formula as substitutes for mothers’ own milk in the feeding of extremely premature infants. Pediatrics. 2005;116:400–6.PubMedCrossRef

79.

•• Sullivan S, Schanler RJ, Kim JH, et al. An exclusive human milk-based diet is associated with a lower rate of necrotizing enterocolitis than a diet of human milk and bovine milk-based products. J Pediatr. 2010;156:562–7. Increasingly, clinicians are finding benefits of an exclusive human milk diet to preterm infants. Although low in protein and other factors, human milk reduces the risk of NEC and promotes improved neurodevelopmental outcomes. Finding the best fortifier is essential, and this article reveals that a human milk derived fortifier augments the protective effect of human milk on reducing the risk of NEC.

80.

Schanler RJ. Outcomes of human milk-fed premature infants. Semin Perinatol. 2011;35:29–33.PubMedCrossRef

81.

Brumberg HL, Kowalski L, Troxell-Dorgan A, et al. Randomized trial of enteral protein and energy supplementation in infants less than or equal to 1250 g at birth. J Perinatol. 2010;30:517–21.PubMedCrossRef

82.

Cooke RW, Lucas A, Yudkin PLN, et al. Head circumference as an index of brain weight in the fetus and newborn. Early Hum Dev. 1977;1:145–9.PubMedCrossRef

83.

Cheong JLY, Hunt RW, Anderson PJ, et al. Head growth in preterm infants: correlation with magnetic resonance imaging and neurodevelopmental outcome. Pediatrics. 2008;121:1534–40.CrossRef

84.

Cooke RW. Are there critical periods for brain growth in children born preterm? Arch Dis Child Fetal Neonatal Ed. 2006;91:F17–20.PubMedCrossRef

85.

Ehrenkranz RA, Dusick AM, Vohr BR, et al. Growth in the neonatal intensive care unit influences neurodevelopment and growth outcomes of extremely low birth weight infants. Pediatrics. 2006;117:1253–61.PubMedCrossRef

86.

Franz AR, Pohlandt F, Bode H, et al. Intrauterine, early neonatal and postdischarge growth and neurodevelopmental outcome at 5.4 years in extremely preterm infants after intensive neonatal nutritional support. Pediatrics. 2009;123:e101–9.PubMedCrossRef

87.

•• Ghods E, Kreissl A, Brandstetter S, et al. Head circumference catch-up growth among preterm very low birthweight infants: effect on neurodevelopmental outcome. J Perinat Med. 2011;39:579–86. This article documents the benefits to neurodevelopmental outcome of preterm infants whose nutrition and lack of illness allowed improved growth of head circumference and thus of the brain.

88.

Claas MJ, de Vries LS, Koopman C, et al. Postnatal growth of preterm born children <750 g at birth. Early Hum Dev. 2011;87:495–507.PubMedCrossRef

89.

Stephens BE, Walden RV, Gargus RA, et al. First-week of protein and energy intakes are associated with 18-month developmental outcomes in extremely low birth weight infants. Pediatrics. 2009;123:1337–43.PubMedCrossRef

90.

Tan MJ, Cooke RW. Improving head growth in very preterm infants—a randomized controlled trial I: neonatal outcomes. Arch Dis Child Fetal Neonatal Ed. 2008;93:F337–41.PubMedCrossRef

91.

Tan MJ, Cooke RW. Improving head growth in very preterm infants—a randomized controlled trial II: MRI and developmental outcomes in the first year. Arch Dis Child Fetal Neonatal Ed. 2008;93:F342–6.PubMedCrossRef

92.

Uhing MR, Das UG. Optimizing growth in the preterm infant. Clin Perinatol. 2009;36:165–76.PubMedCrossRef

93.

•• Jadcheria SR, Peng J, Moore R, et al. Impact of personalized feeding program in 100 NICU infants: pathophysiology-based approach for better outcomes. JPGN. 2012;54;62–70. This article describes a unique approach to personalizing feeding for preterm infants, providing important evidence that such an approach can promote growth better than often rigid standard protocols or random approaches to feeding that are more common in most NICUs.

94.

Eleni dit Trolli S, Kermorvant-Duchemin E, Huon C. Early individualized parenteral nutrition for preterm infants. Arch Dis Child Fetal Neonatal Ed. 2009;94:F152–3.PubMedCrossRef

95.

Riskin A, Shiff Y, Shamir R. Parenteral nutrition in neonatology: to standardize or individualize? Isr Med Assoc J. 2006;8:641–5.PubMed

96.

Smolkin T, Diab G, Shohat I, et al. Standardized versus individualized parenteral nutrition in very low birth weight infants: a comparative study. Neonatology. 2010;98:170–8.PubMedCrossRef

97.

Ehrenkranz RA. Early nutritional support and outcomes in ELBW infants. Early Hum Dev. 2010;86(Suppl 1):21–5.PubMedCrossRef

98.

Martin CR, Brown YF, Ehrenkranz RA, et al. Nutritional practices and growth velocity in the first month of life in extremely premature infants. Pediatrics. 2009;124:649–57.PubMedCrossRef

99.

Lapillonne A, Razafimahefa H, Rigourd V, et al. Intervenants au séminaire Nutrition du premature du GEN-IdF Nutrition of the preterm infant. Arch Pediatr. 2011;18:313–23.PubMedCrossRef

100.

De Curtis M, Rigo J. The nutrition of preterm infants. Early Hum Dev. 2012;88(Suppl 1):S5–7.PubMedCrossRef

Title: Aggressive Nutrition of the Preterm Infant
Author: William W. Hay Jr.
Publication date: 01-12-2013
Publisher: Springer US
Published in: Current Pediatrics Reports / Issue 4/2013
Electronic ISSN: 2167-4841
DOI: https://doi.org/10.1007/s40124-013-0026-4

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Aggressive Nutrition of the Preterm Infant

Abstract

Keynote webinar | Spotlight on medication adherence

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Abstract

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