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Optimal Nutrition for Low Birth Weight infants, Feeding guidelines to meet nutritional requirements of Small for Gestational Age (SGA) infants

Optimal Nutrition for Low Birth Weight infants

Optimal Nutrition for Low Birth Weight infants

Feeding guidelines to meet nutritional requirements of Small for Gestational Age (SGA) infants

Health News Highlights of Nutrition Remarks (July 25, 2013)

Written by Deeksha Sharma, Ph.D, Health News Writer for Nutrition Remarks, Solon, OH, USA

Reviewed by Prof. David Tudehope, Mater Medical Research Institute, South Brisbane, Queensland,  Australia.

Small for gestational age (SGA) means a developing baby in the womb or an infant is smaller in size than normal for the baby’s gender and gestational age. After birth, the goal is to provide enough nutrients to achieve postnatal growth similar to that of normal fetus. Mother’s own milk is recommended for SGA infants, as it meets their nutritional requirements besides providing short and long term benefits. Also, SGA infants need to “room-in” with their mothers to promote breastfeeding, mother-infant attachment, and skin-to-skin contact to assist with thermoregulation.

SGA babies may be constitutionally small and at no greater risk than normal sized babies or small due to intrauterine growth restriction (IUGR). IUGR babies are at higher risk of perinatal morbidity and mortality. Likewise, SGA infants can be term or preterm, where latter category is more at risk of neonatal and infant mortality. Each year, average 16% (more than 20 million) infants are born with Low birth weight (LBW) worldwide.

The main nutrients for the healthy fetus are glucose, lactate, ketone bodies and amino acids. The growth-restricted fetus receives fewer of these nutrients which reduces lean mass, body fat, bone mineral content and glycogen stores and increases the risk of hypoglycemia. Compared with their Appropriate for Gestational Age (AGA) peers oxygen consumption and energy expenditure of SGA infants are high (due to a large brain: body ratio and need for catch-up growth), while fat and protein absorption in SGA infants is lower. While providing postnatal nutrient supply to SGA infant, one must consider the balance of risks associated with under and over feeding. It is recommended that catch-up growth be gradual, not too much and not too fast, as it increases risk for metabolic syndrome (“Thrifty phenotype” hypothesis, where fetal programming for adaptation to an adverse intrauterine environment results an increased insulin resistance and increased risk of hypertension, dyslipidemia, central obesity and type II diabetes associated with excess wt. gain in later life).

Breastfeeding is recommended as the optimal feeding method and nutrition for all infants but is particularly important for SGA infants because it reduce the incidence and/or severity of a wide range of infectious diseases, including necrotizing enterocolitis (NEC), bacterial meningitis, bacteremia, gastroenteritis, respiratory tract infection, otitis media, and urinary tract infection. Breastfeeding decreases the rate of sudden infant death syndrome, and the incidence of insulin-dependent (type I) and noninsulin-dependent (type II) diabetes mellitus, obesity, certain cancers, hypertension, hypercholesterolemia, and asthma in older children and adults. Breastfeeding is also associated with better speech and jaw development and improved visual acuity. Breast milk feeding is preferred over formula feeding because of benefits related to reduced infection and improved neurodevelopment.

Authors conclude that breastfeeding should be promoted and actively supported for SGA infants. They also recommend encouraging kangaroo mother-baby skin-to-skin contact, attempting breastfeeding as early as feasible, and initiating feeds within 30 minutes of birth with breastfeeding or expressed breast milk (mother’s or donor milk). Key principle underpinning feeding guidelines include developmentally supportive care, support of breastfeeding and the individual feeding plan developed by parents and a multidisciplinary team. Intravenous (IV) fluids are recommended if enteral feeding is not possible or problematic hypoglycemia occurs, while continue to place infant on the breast frequently and expressing and administering colostrum. Weight is not the major criteria for discharge of SGA infants rather physical stability, feeding well, starting to gain weight, maternal competency, and adequate community support. Maternal nutritional interventions (iron and other micronutrients) must be focused during preconception or pregnancy to prevent SGA birth.

This news highlight is based on the following article published by Dr. David Tudehope et al. Additional general background information was acquired from PubMed and NIH sources.

 Tudehope D et al. Nutritional requirements and feeding recommendations for small for gestational age infants. J Pediatr. 2013 Mar; 162(3 Suppl):S81-9.