Neonatal Clinic-NICU, University Hospital of Larissa, 413 34 Larissa, Greece.
Neonatal Clinic-NICU, Nikea General Hospital "Agios Panteleimon", 184 54 Piraeus, Greece.
Nutrients. 2023 Jul 21;15(14):3231. doi: 10.3390/nu15143231.
Over the last few decades, there has been an ongoing debate over both the optimal feeding mode for very premature neonates (VPN) as well as what their optimal growth should be. Despite the American Academy of Pediatric declaring since 1997 that the growth of VPN should follow the trajectory of intrauterine fetal growth, differences of opinion persist, feeding policies keep changing, and the growth and development of VPN remains extremely variable not only between countries, but even between neighboring neonatal units. Even the appropriate terminology to express poor postnatal growth (extrauterine growth restriction (EGR) and postnatal growth failure (PGF)) remains a subject of ongoing discussion. A number of recent publications have shown that by implementing breast milk fortification and closely following growth and adjusting nutrition accordingly, as per the consensus guidelines of the major Neonatal Societies, we could achieve growth that closely follows birth centiles. A recent position paper from EPSGAN recommending targeted nutritional support to cover the energy and protein deficits sustained by VPN during periods of critical illness further strengthens the above findings. Conclusion: We can promote better growth of VPN by ensuring a stable administration of sufficient calories and protein, especially in the first 2 weeks of life, implementing breast milk fortification, covering energy and protein deficits due to critical illness, and increasing feeding volumes as per the latest guidelines. The adoption of universal protocol for nutrition and growth of VPN is essential and will enable better monitoring of long-term outcomes for this population.
在过去的几十年里，对于极低出生体重儿（very premature neonates，VPN）的最佳喂养方式以及他们的最佳生长速度一直存在争议。尽管美国儿科学会自 1997 年以来宣布 VPN 的生长速度应遵循宫内胎儿生长轨迹，但仍存在意见分歧，喂养政策不断变化，VPN 的生长和发育不仅在国家之间，甚至在相邻的新生儿单位之间也存在极大的差异。甚至表达不良产后生长（extrauterine growth restriction，EGR 和 postnatal growth failure，PGF）的适当术语也仍是一个正在讨论的话题。最近的一些出版物表明，通过实施母乳强化，并根据主要新生儿学会的共识指南密切关注生长并相应调整营养，可以实现与出生百分位密切相关的生长。最近 EPSGAN 的一份立场文件建议对 VPN 在危重病期间持续存在的能量和蛋白质不足进行有针对性的营养支持，进一步加强了上述发现。结论：通过确保稳定给予足够的热量和蛋白质，特别是在生命的前 2 周，实施母乳强化，弥补因危重病而导致的能量和蛋白质不足，并根据最新指南增加喂养量，我们可以促进 VPN 更好地生长。采用 VPN 的营养和生长通用方案至关重要，这将能够更好地监测该人群的长期结局。
