5.04 CME

Optimizing Enteral Nutrition in Preterm Units

Pembicara: Dr. Sanjay Wazir

DM (Neonatology), MD (Pediatrics)

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Keterangan

The panel discussion on "Optimizing Enteral Nutrition in Preterm Units" highlights growth and development in premature infants. It involves carefully balancing the delivery of essential nutrients like proteins, fats, and vitamins to meet the specific needs of these vulnerable infants. Early and gradual introduction of enteral feeds can help prevent complications like necrotizing enterocolitis (NEC). Advanced feeding protocols, alongside close monitoring, ensure that preterm infants receive the optimal nutrition required for healthy development. This approach significantly improves long-term outcomes and reduces the risk of malnutrition.

Ringkasan

  • The discussion centers on the challenges of providing optimal enteral nutrition to premature infants, especially those under 1000 grams. Healthcare providers face difficulties related to the baby's gastrointestinal immaturity, the risk of necrotizing enterocolitis (NEC), and feed intolerance. There is significant variation in feeding practices across different neonatal units, leading to inconsistent outcomes. Parental concerns and lack of support for mothers' breast milk production further complicate the process.
  • Aggressive nutrition protocols aim to improve growth, brain development, and reduce morbidities like chronic lung disease and retinopathy of prematurity. However, they also carry risks, including an increased risk of NEC, electrolyte imbalances, and feed intolerance. Balancing the benefits and risks is crucial for optimal outcomes. Parental nutrition is often necessary for very premature infants, but enteral nutrition is preferred whenever possible due to fewer complications. Transitioning from parental to enteral nutrition requires careful monitoring and gradual increases in enteral feeds.
  • Markers for monitoring protein supplementation effectiveness include weight gain, length, head circumference, and blood urea nitrogen levels. Pre-albumin is also a sensitive marker of protein nutrition. Long-term neurodevelopmental outcomes indicate overall nutritional adequacy.
  • Refeeding syndrome is a risk in babies who have been without enteral feeding for a prolonged period. It is associated with electrolyte imbalances and insulin issues. Calcium and phosphorus supplementation are essential in pre-term infants, but their ratio must be carefully maintained to prevent disturbances and osteopenia. Organic sources of these minerals are preferred due to better bioavailability and reduced precipitation.
  • The choice between preterm formula and fortified human milk affects nutrient absorption, with human milk being the gold standard. Calcium phosphate supplementation in parental nutrition requires careful monitoring of ionic calcium levels. During the transition to human milk fortification, it is crucial to prevent demineralization by monitoring calcium intake and the calcium-to-phosphorus ratio.
  • Health care professionals should communicate nutritional red flags to families at discharge, including inadequate growth, feeding difficulties, lethargy, reduced urine output, and developmental delays. Adjusting nutritional requirements in preterm infants with delayed care requires a focus on providing normal recommended nutrition, addressing protein deficiencies, and carefully monitoring electrolyte balance.

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