Nutritional practices in the neonatal intensive care unit: analysis of a 2006 neonatal nutrition survey.

Objective: The goal of this investigation was to determine how current parenteral nutrition and enteral nutrition practice intentions for preterm infants compare with published recommendations and previous feeding practices.

Methods: A survey of feeding strategies for 3 preterm infant weight groups was sent to NICU directors, neonatal fellowship directors, neonatologists, neonatal nurse practitioners, and neonatal dieticians. A total of 775 surveys were distributed by both electronic and standard mail services.

The neonatologist's dilemma: catch-up growth or beneficial undernutrition in very low birth weight infants-what are optimal growth rates?

As the threshold of viability decreases, clinicians who care for preterm neonates increasingly are faced with making decisions regarding feeding in a population for which there are no clear guidelines and minimal scientific data to inform optimal nutritional strategies. It is becoming more apparent that the amount of nutrition, as well as the timing of nutrient delivery, may affect long-term growth and metabolic outcomes. Both overnutrition and undernutrition at critical growth periods may have adverse effects.

Achieving positive protein balance in the immediate postoperative period in neonates undergoing abdominal surgery.

Objectives: To determine whether neonates undergoing major abdominal surgical procedures in the first day of life could achieve a positive protein balance without protein toxicity in the immediate perioperative period by using parenteral amino acids and fentanyl analgesia.

Study Design: Newborns undergoing major surgery for gastroschisis in the first 24 hours of life (n = 13) were alternately allocated to immediate postoperative parenteral administration of 1.5 g/kg(-1)/day(-1) versus 2.

Early aggressive nutrition in very preterm infants.

Despite numerous advances in the nutrition of preterm infants, the increasing survival at lower birth weights is resulting in a new frontier of extrauterine nutritional support of these vulnerable infants. The extremely low birth weight infant has endogenous energy to maintain energy balance for only 3-4 days without an exogenous energy supply. Nevertheless, many clinicians are still hesitant to introduce substrates at high rates early in life secondary to concerns of intolerance and toxicity.

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.

Blood urea nitrogen concentration as a marker of amino-acid intolerance in neonates with birthweight less than 1250 g.

Objective: Currently blood urea nitrogen (BUN) is commonly used as a marker of protein intolerance in very preterm infants. The purpose of this study was to evaluate the relationship between amino-acid intakes and BUN concentrations during the early neonatal period in preterm neonates.

Study Design: Retrospective review of BUN concentration data from 121 infants with birthweight View Article and Find Full Text PDF

Effect of low versus high intravenous amino acid intake on very low birth weight infants in the early neonatal period.

Greater protein intakes are required than have been commonly used to achieve fetal in utero protein accretion rates in preterm neonates. To study the efficacy and safety of more aggressive amino acid intake, we performed a prospective randomized study in 28 infants [mean wt, 946 +/- 40 g (SEM)] of 1 (low amino acid intake, LAA) versus 3 g.kg(-1).

Aggressive nutrition of the very low birthweight infant.

We propose an approach to nutrition of the VLBW infant that aims at minimizing the interruption of nutrient uptake engendered by premature birth. Our approach is aggressive in that it goes beyond current practice in several key aspects. The gap in nutrient intakes between the proposed aggressive approach and current practice will most likely disappear over the next few years as today's aggressive practice becomes tomorrow's standard practice.

Ovine placental and fetal arginine metabolism at normal and increased maternal plasma arginine concentrations.

Arginine (A) may play a significant role in fetal growth, by stimulating insulin secretion and as a precursor for both polyamine synthesis and nitric oxide production. To determine whether increased maternal plasma A concentrations can enhance delivery of A to the fetus, uterine, umbilical, and net uteroplacental (UP) A uptake rates were measured in 12 pregnant ewes at 129.6 +/- 0.