Use of Protein in Nutritional Strategies for Very-Low-Birth-Weight (VLBW) Infants to Promote Adequate Growth

David H. Adamkin, M.D.

Professor of Pediatrics, University of Louisville; Associate Director of the Neonatal Fellowship Program and Direc­tor of Neonatal Nutrition Research. Dr. Adamkin is an experienced researcher in Neonatal Nutrition. He is a Neonatologist with over 100 articles published, 40 book chapters, 5 books and 20 webinars dealing with methods and strategies to nourish premature infants. He is a pioneer in human milk analysis.

Importance of Early Nutrition

The neonatal period represents a time in which the brain is especially vulner­able to nutritional deficits, therefore, attention to detail of nutritional man­agement is critical particularly for the VLBW infant (<1500 grams) who has missed the last trimester of pregnancy.

Human Milk 

Human milk, beyond the initial trophic feeds, either from mother’s own milk or from pasteurized donor human milk, are a priority for all preterm infants, especially VLBW infants. The American Academy of Pediatrics (AAP) recommendation on breastfeeding management of preterm babies in 2012 included the numerous potent benefits of human milk, as such that all preterm infants should receive human milk, and that mother‘s own milk, fresh or frozen, should be the primary diet and requires a multi-nutrient fortifica­tion to meet the nutritional demands.

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References

1. Meinzen Derr J et al. Role of human milk in extremely low birth weight infants’ risk of necrotizing enterocolitis or death. J Perinatol. 2009;29(1):57-62.

2. Boundy EO et al. Disparities in Hospital Reported Breast Milk Use in Neonatal Intensive Care Units – United States, 2015. MMWR Morb Mortal Wkly Rep. 2017;66:1313-1317. http://dx.doi.org/10.15585/mmwr.mm6648a1.

3. Goldberg DL et al. Identifying Malnutrition in Preterm and Neonatal Populations: Recommended Indicators. J Acad Nutr Diet. 2018;(9). doi:10.1016/j.jand.2017.10.006. https://clicktime.symantec.com/36JswLLTSCtennEEybwiuYy6H2?u=http%3A%2F%2Fwww.nutritioncare.org%2FuploadedFiles%2FDocuments%2FMalnutrition%2FMalnutrition%2520Indicators%2520in%2520Preterm%2520and%2520Neonatal%2520Populations%2520Card.pdf

4. American Academy of Pediatrics Committee on Nutrition. Kleinman RE, Greer FR, eds. Pediatric Nutrition. 8th ed. Itasca, IL: American Academy of Pediatrics; 2019.

5. Valentine CJ, Hurst NM, Schanler RJ. Hindmilk improves weight gain in low-birth-weight infants fed human milk. J Pediatr Gastroenterol Nutr. 1994;18:474–477.

6. Koletzko B, Poindexter B, Uauy R, eds. Nutritional Care of Preterm Infants: Scientific Basis and Practical Guidelines. Basel, Switzerland: Karger; 2014.

7. O’Conner DL et al. Nutrient enrichment of human milk with human and bovine milk-based fortifiers for infants born weighing <1250 g: a randomized clinical trial. Am J Clin Nutr. 2018;108:108–116. https://doi.org/10.1093/ajcn/nqy067. [/av_textblock] [/av_one_full][av_hr class='invisible' icon_select='yes' icon='ue808' font='entypo-fontello' position='center' shadow='no-shadow' height='50' custom_border='av-border-thin' custom_width='50px' custom_margin_top='30px' custom_margin_bottom='30px' custom_border_color='' custom_icon_color='' id='' custom_class='' template_class='' av_uid='av-kobhoz1o' sc_version='1.0' admin_preview_bg=''] [av_one_full first min_height='' vertical_alignment='av-align-top' space='' row_boxshadow_color='' row_boxshadow_width='10' custom_margin='aviaTBcustom_margin' margin='40px' margin_sync='true' mobile_breaking='' mobile_column_order='' min_col_height='' padding='60px' padding_sync='true' svg_div_top='' svg_div_top_color='#333333' svg_div_top_width='100' svg_div_top_height='50' svg_div_top_max_height='none' svg_div_top_opacity='' svg_div_bottom='' svg_div_bottom_color='#333333' svg_div_bottom_width='100' svg_div_bottom_height='50' svg_div_bottom_max_height='none' svg_div_bottom_opacity='' border='' border_style='solid' border_color='' radius='0px' radius_sync='true' column_boxshadow_color='' column_boxshadow_width='10' background='bg_color' background_color='' background_gradient_direction='vertical' background_gradient_color1='' background_gradient_color2='' background_gradient_color3='' src='http://www.synovaassociates.com/wp-content/uploads/2022/01/Untitled-design-2.png' attachment='2602' attachment_size='full' background_position='center center' background_repeat='stretch' highlight_size='1.1' animation='' link='' linktarget='' link_hover='' title_attr='' alt_attr='' mobile_display='' mobile_col_pos='0' id='brochureagenda' custom_class='' template_class='' aria_label='' av_uid='av-kobwe8db' sc_version='1.0'] [av_textblock textblock_styling_align='' textblock_styling='' textblock_styling_gap='' textblock_styling_mobile='' size='' av-medium-font-size='' av-small-font-size='' av-mini-font-size='' font_color='custom' color='#ffffff' id='' custom_class='' template_class='' av_uid='av-kobw6duw' sc_version='1.0' admin_preview_bg='']

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