Low birthweight infants: immediate feeding recalled

Achieving optimal feeds for preterm babies, recommendations and realities in practice: nigerian perspective

Preterm deaths are responsible for the highest number of neonatal mortality in Nigeria. Preterm nutrition contributes significantly to overall outcome particularly as it relates to neurodevelopment. Recently, new guidelines for enteral feedings in premature infants were issued by the American Academy of Paediatrics and European Society of Pediatric Gastroenterology, Hepatology and Nutrition Committee on Nutrition. Nevertheless, in clinical practice it is often difficult to attain suggested intakes at all times. The situation is worse in Nigeria where there are no specific national guidelines and recommendations derived from local data targeting Preterms. There is a high possibility of significant potential cumulative nutritional deficits occurring in Nigerian preterms. The inevitable suboptimal intake contributes significantly to the incidence of neonatal diseases and outcome. This review describes practical ways of optimizing nutritional intake in these vulnerable neonates with reference to Nigerian situation. Understanding the preterm gut, initiation of parenteral nutrition, need for minimal enteral feeds, ensuring adequate macro and micronutrients intake and need for follow up are discussed. There are limitations to the practice of the recommended preterm nutrition in Nigerian settings, nevertheless the interventions like early commencement of minimal enteral feeds and preference for human breast milk should be practiced optimally. Hence, all health professionals should acknowledge that preterm nutrition may be an emergency and need to improve their knowledge on when and how to achieve optimal feeds in them. There is a dare need through both clinical practice as well as research, to reduce nutritional deficits in these vulnerable infants.

Preterm outcomes research: a critical component of neonatal intensive care

While early preterm outcome studies described the lives of preterm survivors to justify the efforts required to save them, subsequent studies demonstrated their increased incidence of cerebral palsy, mental retardation, sensory impairments, minor neuromotor dysfunction, language delays, visual-perceptual disorders, learning disability and behavior problems compared to fullterm controls. Because infants born at the lower limit of viability require the most resources and have the highest incidence of neurodevelopmental disability, there is concern that resources have gone primarily to neonatal intensive care and are not available for meeting the followup, health, educational and emotional needs of these fragile infants and their families. Despite many methodological concerns, preterm outcome studies have provided insight into risk factors for and causes of CNS injury in preterm infants. Nevertheless, it remains difficult to predict neurodevelopmental outcome for individual preterm infants. Perinatal and neonatal risk factors are inadequate proxies for neurodevelopmental disability. Recent randomized controlled trials with one to five year neurodevelopmental followup have provided valuable information about perinatal and neonatal treatments. Recognizing adverse longterm neurodevelopmental effects of pharmacological doses of postnatal steroids is a sobering reminder of the need for longterm neurodevelopmental followup in all neonatal randomized controlled trials. Ongoing longterm preterm neurodevelopmental studies, analysis of changes in outcomes over time and among centers, and evaluation of the longterm safety, efficacy and effectiveness of many perinatal and neonatal management strategies and proposed neuroprotective agents are all necessary for further medical and technological advances in neonatal intensive care.

Battle of the clotbusters

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