Aggressive enteral nutrition in preterm neonates

Abstract

Extrauterine growth restriction (EUGR) is a serious issue in extremely preterm (gestation under 28 weeks) neonates. Suboptimal nutrition and growth in the early postnatal life have been associated with impaired neurodevelopmental outcomes and growth in this population. Delay in commencing feeds, being too conservative whilst upgrading feeds, stopping feeds in presence of perceived risk factors for NEC, and failure to provide optimal balanced protein calorie intake during the critical early postnatal life, are the important contributors for EUGR. The concept of aggressive enteral nutrition has been widely accepted following the realisation of the frequency and consequences of EUGR in extremely preterm neonates. It is important to note that aggressive enteral nutrition is easier to advocate than practice considering the inherent limitations imposed on how much and how fast a preterm neonate can be fed without increasing the risk of NEC or long term adverse effects. This chapter provides a close scrutiny of the current evidence to assess if the safe upper limits of various aspects of aggressive enteral feeding of extremely preterm neonates are well defined and adequately assessed. The evidence for the management of manifestations of feed intolerance/ileus of prematurity (e.g., abdominal distension, large/bile stained gastric residuals) is also reviewed and guidelines for further research are provided.