Nutrition in preterm infants: A review of optimised oral and parenteral nutritional strategies Nutrition chez les nourrissons prématurés: revue des stratégies nutritionnelles orales et parentérales optimisées
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Abstract
Background: Nutrition is a cornerstone of a preterm infant's life, providing the essential nutrients required to support the body's fundamental functions ensures survival. However, meeting the nutritional needs of preterm neonates presents unique challenges, as their feeding requirements far exceed those of full-term infants. Despite advancements in feeding strategies, poor growth rates and neurocognitive disabilities remain prevalent in this population, largely due to feeding difficulties, increased respiratory workload, and immature gastrointestinal systems.
Objective: This review seeks to explore preterm nutrition and the availability of sufficient nutrients for the support, growth and weight gain of preterm infants in a manner comparable to a fetus of the same gestational age.
Method: This narrative review investigates the physiological effects of preterm birth on infant organ systems, the distinctive nutritional needs of preterm neonates, and the various factors influencing their nutritional status, such as mode of delivery, maternal corticosteroid use, breastfeeding practices. It also examines current nutritional strategies, including intravenous administration of dextrose, amino acids, and lipids for severely preterm infants.
Key Findings: Preterm infants face unique challenges such as underdeveloped organs, environmental challenges which do not exist in the third trimester in the uterus but exist in neonatal care units.
Conclusion: Breast milk is key for preterm nutrition. Its fortification especially for infants that are very preterm is recommended if the mother lacks of access to an ideal diet. Administration of micronutrients such as Iron, Zinc, Vitamin D, E, K, and A help prevent preterm morbidity and mortality. The administration of probiotics to preterm infants to improve GUT maturity and digestion is currently under consideration.
Résumé
Contexte: La nutrition est un pilier essentiel à la survie du nourrisson prématuré. Fournir les nutriments indispensables au maintien des fonctions vitales garantit sa survie. Cependant, répondre aux besoins nutritionnels des nouveau-nés prématurés pose des défis particuliers, car leurs besoins alimentaires dépassent largement ceux des nourrissons nés à terme. Malgré les progrès réalisés en matière de stratégies d'alimentation, les retards de croissance et les troubles neurocognitifs restent fréquents dans cette population, principalement en raison des difficultés d'alimentation, d'une charge respiratoire accrue et d'un système gastro-intestinal immature.
Objectif: Cette revue vise à explorer la nutrition des prématurés et la disponibilité de nutriments suffisants pour soutenir la croissance et la prise de poids, de manière comparable à un fœtus du même âge gestationnel. Méthode: Cette revue narrative examine les effets physiologiques de la prématurité sur les systèmes organiques du nourrisson, les besoins nutritionnels spécifiques des nouveau-nés prématurés et les différents facteurs influençant leur état nutritionnel, tels que le mode d'accouchement, l'utilisation de corticostéroïdes par la mère et les pratiques d'allaitement. Elle examine également les stratégies nutritionnelles actuelles, notamment l'administration intraveineuse de dextrose, d'acides aminés et de lipides pour les nourrissons très prématurés.
Principaux résultats: Les nourrissons prématurés sont confrontés à des défis uniques, tels que le sousdéveloppement de leurs organes et des facteurs environnementaux qui n'existent pas au cours du troisième trimestre de grossesse, mais qui sont présents dans les unités de soins néonatals.
Conclusion: Le lait maternel est essentiel à la nutrition des prématurés. Son enrichissement, notamment pour les grands prématurés, est recommandé si la mère n'a pas accès à une alimentation optimale. L'administration de micronutriments tels que le fer, le zinc et les vitamines D, E, K et A contribue à prévenir la morbidité et la mortalité liées à la prématurité. L'administration de probiotiques aux prématurés afin d'améliorer la maturation du microbiote intestinal et la digestion est actuellement à l'étude.
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