DOC

Enteral nutrient supply for preterm infants

By Jesus Rogers,2014-05-26 22:04
10 views 0
Enteral nutrient supply for preterm infants

Enteral nutrient supply for preterm infants. A comment of the ESPGHAN

    Committee on Nutrition.

    123ESPGHAN Committee on Nutrition and invited expert guests: C. Agostoni; Buonocore G, Carnielli VP

    45678910M. De Curtis, Darmaun D, T. Decsi; M. Domellöf, N.D. Embleton, C. Fusch, Genzel-Boroviczeny O,

    11121314* #1516175 O. Goulet;Kalhan S.C. S. Kolacek; B. Koletzko, A. Lapillonne, W. Mihatsch, L. Moreno;

    1819202122*2324252627?Neu J, Poindexter B, J. Puntis, Putet G , J.Rigo, Riskin A, Salle B, Sauer P, R. Shamir; H.

    282930*31Szajewska; Thureen P, D. Turck, J.B. van Goudoever, Ziegler E.

    *Project steering committee, # Committee on Nutrition Chair, ?Committee on Nutrition Secretary

1210 Department of Paediatrics, San Paolo Hospital, University of Milan, Italy; Pediactrics, Obstetrics and

    3Reproductive Medicine, University of Siena, Italy; Division of Neonatology, Salesi Hospital,

    45Polytechnical University of Marche, Ancona, Italy; University of Rome, Italy; Centre Hospitalier,

    67Universitaire de Nantes, France; Department of Paediatrics, University of Pecs, Hungary; Department of

    8paediatrics Umeå University, Sweden; Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom; 91015 Ernst-Moritz-Arndt-University, Greifswald, Germany; Neonatologie Klinikum der Universität München,

    1112Germany; Hôpital Necker Enfants-Malades, University of Paris Descartes, Paris, France; Cleveland

    13Clinic Lerner College of Medicine, Case Western Reserve University, USA; Children’s Hospital, Zagreb

    14Medical University, Croatia; Dr von Hauner Children’s Hospital, University of Munich, Germany;

    1516Hôpital Saint-Vincent de Paul, Paris, France; Deaconry Hospital, Schwaebisch Hall, Germany; 171820 Escuela Universitaria de Ciencias de la Salud, Zaragoza, Spain; Department of paediatrics, University

    19of Florida, Gainesville, USA; Section of neonatal, Indiana University, School of Medicine, Indianapolis,

    2021USA; Leeds General Infirmary, Leeds, UK; Service de Néonatologie Réanimation néonatale, Hôspital

    2223de la Croix Rousse, Lyon, France; CHR Citadelle, University of Liege, Belgium; Bnai Zion Medical

    24Center, Haifa, Israel; Service de Medicine de la Reproduction, Hôspital Edouard Herriot, Lyon, France; 2526 25 Department of paediatrics, University Medical Centre Groningen, The Netherlands; Schneider

    27Children's Medical Center, Tel-Aviv University, Tel Aviv, Israel; The Medical University of Warsaw,

    2829Poland; University of CO Health Sciences Center, Denver, USA; Jeanne de Flandre Children’s

    30Hospital/University of Lille, France; Erasmus MC - Sophia Children's Hospital, Rotterdam, the

    31Netherlands; Fomon Infant Nutrition Unit, Children’s Hospital, University of Iow, USA

    30

     1

Acknowledgements: A scientific workshop held to discuss the draft recommendations with invited expert

guests was financially supported by unrestricted educational grants donated by Danone Baby Nutrition

(then Nutricia Baby Foods), Mead Johnson Nutritionals, and Nestlé Nutrition to and administered by the

Charitable Child Health Foundation, Munich, Germany (www.kindergesundheit.de). All meetings and the

    35 writings of the manuscripts were performed without any participation of representatives or employees of commercial enterprises, and subjects and contents of the guideline were in no way influenced by the supporting companies.

Correspondence:

    40 Prof. Dr. J.B. van Goudoever, MD PhD

    Division of Neonatology, Department of Peadiatrics, Sophia Children’s Hospital Erasmus Medical Center,

    Rotterdam, The Netherlands, Tel: +31-10-7036077, Fax:+31-10-7036811

     2

45

    Abstract ....................................................................................................................................... 4

    Introduction ................................................................................................................................. 4

    Fluid ............................................................................................................................................ 5

    Energy ......................................................................................................................................... 6 50 Protein ........................................................................................................................................ 8

    Lipids ......................................................................................................................................... 9

    Carbohydrates<.......................................................................................................................... 12

    Minerals .................................................................................................................................... 14

    Trace elements ........................................................................................................................... 20 55 Vitamins .................................................................................................................................... 24

    Pre- and Probiotics ..................................................................................................................... 32

    Nucleotides ................................................................................................................................ 34

    Choline ...................................................................................................................................... 35

    References ................................................................................................................................. 37 60 Tables ........................................................................................................................................ 50

     3

    Abstract (235 words)

    The number of surviving children born prematurely have increased substantially over the last two decades. 65 The major goal of enteral nutrient supply to these infants is to achieve growth similar to foetal growth

    coupled with satisfactory functional development. The accumulation of knowledge since the previous

    guideline on nutrition of preterm infants from the Committee on Nutrition of the European Society of

    Paediatric Gastroenterology and Nutrition in 1987, has made a new guideline necessary. Thus, an ad hoc

    Expert Panel was convened by the Committee on Nutrition of the European Society of Paediatric 70 Gastroenterology, Hepatology and Nutrition in 2007 to make appropriate recommendations. The present

    guideline is consistent with, but not identical to, recent guidelines from the Life Sciences Research Office

    of the American Society for Nutritional Sciences published in 2002 and recommendations from the

    handbook "Nutrition of the preterm infant. Scientific basis and practical application", edited by Tsang et al,

    nd ed. published in 2005. The preferred food for premature infants is fortified human milk from the infant's 2

    75 own mother, or alternatively formula designed for premature infants. This guideline aims provides

    proposed advisable ranges for nutrient intakes for stable growing preterm infants up to a weight of

    approximately 1800 gram, since most data are available for these infants. These recommendations are

    based on a considered review of available scientific reports on the subject, and on expert consensus where

    the available scientific data is considered inadequate.

    80

    Key words: Child Development, Embryonic and Fetal Development, *Premature infant feeding,

    *Nutritional Requirements

     4

85 Introduction

    In 1987 the European Society of Paediatric Gastroenterology and Nutrition published recommendations on

    nutrition and feeding of preterm infants [1] to provide guidance on feeding of preterm infants. Even though

    extensive reviews on the topic have recently been published [2, 3], the ESPGHAN Committee on Nutrition

    considered it necessary to review the recommendations on nutrient needs of preterm infants. 90 An expert group reviewed the existing evidence and prepared draft manuscripts on advisable intakes of

    macro- and micro-nutrients for preterm infants. These proposals were reviewed and discussed in detail at a

    scientific workshop organised by the charitable Child Health Foundation (www.kindergesundheit.de) in

    March 2007. This meeting was attended by observing experts in infant formula design and manufacturing

    (listed in footnote 1) who were asked to provide advice on the feasibility of producing food products based 95 on the recommendations made.

    The aim of this report is to provide guidance on quantity and quality of nutrients needed for preterm infants,

    so as to achieve growth similar to foetal growth coupled with satisfactory functional development. The

    recommendations relate to ranges of enteral intakes for stable growing preterm infants up to a weight of

    approximately 1800 gram, since most data are available for these infants. No specific recommendations are 100 provided for infants with a weight below 1000 gram as data is lacking for this group for most nutrients,

    except for protein needs. The needs of infants with specific diseases (e.g. bronchopulmonary dysplasia,

    congenital heart disease or short bowel syndrome) and those receiving parenteral nutrition have been

    reviewed recently [4] and are not specifically addressed in this report.

    The Committee advocates the use of human milk for preterm infants as standard practice, provided it is 105 fortified with added nutrients where necessary to meet requirements. Parents and health care providers

    should be aware that human milk composition may vary over the duration of lactation, within the day and

    even during one expression. Also the treatment following expression, e.g. storage or pasteurisation, may

    influence composition. Alternatively to human milk, preterm formula may be used. This comment focuses

    on providing guidance on appropriate nutrient intakes with fortified human milk or formula. 110