Interventional strategies to promote appropriate growth.

Appropriate growth of premature infants can be defined as growth that is not associated with adverse consequences in the short and the long term. Growth failure is associated with neurocognitive impairment. The goal of nutritional management therefore is the achievement of appropriate growth by ensuring that nutrient intakes are maintained at all times at adequate levels. Many impediments stand in the way of this goal. Parenteral administration of nutrients must begin immediately at birth and needs to be continued until enteral nutrition is fully established. While nutritional support is provided by parenteral nutrition, gut priming, also beginning at birth, stimulates the immature gastrointestinal tract to undergo maturation. Human milk is the preferred agent for gut priming because it is more effective and safer than alternative agents. As a source of nutrients, however, human milk is incomplete for the premature infant and requires supplementation (fortification) with nutrients. At the authors' institution, commercial human milk fortifiers and additional sources of protein are being used in efforts to achieve appropriate growth. Data from the authors' institution indicate that nutrient intakes, especially intakes of protein, have improved in recent years and are approaching adequate levels. Accordingly, growth of infants has improved to the point where on average only a mild degree of postnatal growth failure is observed.