Preterm Infant (VLBW) Enteral Nutrition

VLBW: Executive Summary of Recommendations (2020)

Executive Summary of Recommendations  
Below are the recommendations and ratings for the Academy of Nutrition and Dietetics Preterm Infant Evidence-Based Nutrition Practice Guideline. Use the links on the left to view the Guideline Introduction. Detailed recommendations, including the evidence supporting these recommendations, is available from the Major Recommendations tab.

  • For  a description of the Academy Recommendation Rating scheme (Strong, Fair, Weak, Consensus, Insufficient Evidence), click here.
  • For a description of the GRADE Recommendation Rate scheme (Level 1 (1A, 1B, 1C, 1D), Level 2 (2A, 2B, 2C, 2D), click here

  • Nutrition Intervention
    VLBW: Protein Amount
    Healthcare practitioners should provide 3.5g to 4.0g of protein per kg bodyweight via enteral nutrition to very low birthweight (less than or equal to 1,500g) preterm infants. Protein intake at 3.5g to 4.0g per kg bodyweight supports superior growth and protein accretion compared to protein intake of less than 3.5g per kg bodyweight.
    Fair
    Imperative
    VLBW: Type of Fat
    Health care practitioners should not routinely supplement additional enteral long chain fatty acids [docosahexaenoic acid (DHA), eicosapantaenoic acid (EPA), and arachidonic acid (AA]) for very low birthweight (less than or equal to 1,500g at birth) preterm infants. If health care practitioners choose to supplement additional omega-3, then AA should also be provided. Current evidence does not suggest consistent benefits with enteral long chain fatty acid supplementation. 
    Fair
    Imperative
    VLBW: Human Milk Fortification
    Healthcare practitioners should fortify human milk fed to very low birth weight preterm infants because fortification increases weight gain and head circumference growth compared to human milk alone.
    Weak
    Imperative
    VLBW: Formula Enrichment
    When human milk is not available, healthcare practitioners should provide very low birthweight (less than or equal to 1,500g) preterm infants with preterm infant formulas that provide higher nutrient density than standard infant formula. Nutrient-dense preterm formulas appear to more closely match the nutritional needs of very low birthweight preterm infants and long clinical experience with preterm formulas suggests that they support good growth, and both functional, and biochemical measures of nutritional adequacy.  
    Consensus
    Conditional
    VLBW: Mother's Milk
    Health care practitioners should provide fortified mother's milk, when available, to VLBW (less than or equal to 1,500g) preterm infants. Mother's own milk intake is associated with lower odds of retinopathy of prematurity when compared to exclusive formula, and there is evidence of a negative dose-response relationship with sepsis and a positive dose-response relationship with Bailey development scores.
    Fair
    Conditional
    VLBW: Human Milk (Mother's and Donor)
    Health care practitioners should provide fortified human milk regardless of source (mother's or donor) to very low birth weight (less than or equal to 1,500g) infants when available. Growth should be monitored by practitioners and the nutrition care plan should be adjusted as appropriate.
    Weak
    Conditional
    VLBW: Mothers' Milk Supplementation
    When quantity of mothers’ milk is insufficient, health care practitioners should supplement VLBW (less than or equal to 1,500g) preterm infants with donor milk during the time that the infant is at high risk for necrotizing enterocolitis (NEC). VLBW preterm infants fed mother's own milk supplmented with donor milk had a lower risk of NEC compared to those fed mother's own milk supplemented with formula.
    Fair
    Conditional
 

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