Growth management in preterm infants
- Ian J Griffin, MB ChB
Ian J Griffin, MB ChB
- Professor, Department of Pediatrics
- UC-Davis, Sacramento, CA
- Section Editors
- Steven A Abrams, MD
Steven A Abrams, MD
- Section Editor — Neonatology
- Professor, Department of Pediatrics
- Dell Medical School at the University of Texas at Austin
- Kathleen J Motil, MD, PhD
Kathleen J Motil, MD, PhD
- Section Editor — Pediatric Nutrition
- Professor of Pediatric Nutrition
- Baylor College of Medicine
Growth impairment during early infancy, a period of substantial cellular hyperplasia and hypertrophy, can have permanent detrimental effects. Abnormalities in growth during this time period may persist into adulthood, especially in patients who were preterm infants. This was illustrated in a report of very low birth weight (VLBW, <1500 g) infants who were twice as likely to have a height less than the third percentile at 20 years of age than that of normal birth weight (BW) controls (10 versus 5 percent) .
Preterm infants are at risk for poor growth while in the neonatal intensive care unit (NICU) and after discharge from the NICU. They must be closely monitored and may require interventions to promote better growth.
Growth in the preterm infant, including monitoring of growth and managing growth impairment while in the NICU and after discharge, will be discussed here. Enteral and parenteral nutrition for preterm infants are discussed separately. (See "Approach to enteral nutrition in the premature infant" and "Parenteral nutrition in premature infants".)
NORMATIVE GROWTH DATA
Normative growth data are available for healthy term infants. However, data are limited for preterm infants during both hospitalization and after discharge. (See "Normal growth patterns in infants and prepubertal children", section on 'Evaluation of growth'.)
Term infants — Normative data are available for intrauterine growth in the last trimester and during infancy [2,3]:
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- Mizuno K, Nishida Y, Taki M, et al. Infants with bronchopulmonary dysplasia suckle with weak pressures to maintain breathing during feeding. Pediatrics 2007; 120:e1035.
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- Horemuzova E, Amark P, Jacobson L, et al. Growth charts and long-term sequelae in extreme preterm infants--from full-term age to 10 years. Acta Paediatr 2014; 103:38.
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- NORMATIVE GROWTH DATA
- Term infants
- Preterm infants
- - Growth chart
- GROWTH IN THE NICU
- Need for adequate intake
- Caloric goals
- Cue-based feeding
- DISCHARGE PLANNING
- AFTER DISCHARGE
- Monitoring of growth
- - Head circumference
- - Laboratory studies
- Routine nutrient supplementation
- - Formula-fed infants
- - Human milk-fed infants
- Poor oral feeding
- Bronchopulmonary dysplasia
- LONG-TERM OUTCOME
- Neurodevelopmental outcome
- SUMMARY AND RECOMMENDATIONS