VLBW: Scope of Guideline (2020)
Guideline Scope Characteristics
The purpose of this guideline is to provide evidence-based nutrition practice guidelines for VLBW (less than or equal to 1, 500 grams at birth) preterm infants. Preterm infants are those born prior to 37 weeks gestation. Another goal of this guideline is to examine available evidence in an attempt to address controversial nutrition topics in the literature and practice.
As the science of neonatology progressed, VLBW infants of younger gestational ages were able to survive. In 1977, these infants’ nutrition needs, other than calories, had not yet been defined. In the 1980’s, nutrition was still being introduced gradually and cautiously to VLBW preterm infants, due to concerns about their inability to metabolize nutrients as well as immature metabolic pathways and immature abilities to suck and swallow.
A clinical trial of various parenteral protein intakes (0g to 2.9g per kg/ per day, two infants over 2.0g per kg per day), conducted by Thureen et al in 2003, seemed to be a turning point, which contributed to a change of focus to the need to provide nutrition early and adequately to preterm infants.
At the same time that knowledge and attitudes toward nutrition support is progressing, these infants continue to provide challenges to the neonatal health care team to support their respiratory, cardiovascular and other immature systems, so providing adequate nutrition continues to be a challenge. These challenges make the RDN an important health care team member, who prioritizes nutrition and advocates for optimal nutrition as a part of the infant’s care with the other health care team members.
Nutrition protocols are important to facilitate adequate nutrition provision. Nutrition protocols need to be evidence informed.
For this guideline, the workgroup sought to ask nutrition intervention questions to provide evidence-based nutrition recommendations to guide nutrition care for VLBW preterm infants. Based on the results of the preterm scoping review there was gap in available evidence-based enteral nutrition recommendations for VLBW preterm infants.
The purpose of the VLBW Preterm Infant Enteral Nutrition Evidence-based Nutrition Practice Guideline is to serve as a baseline for enteral nutrition support. Due to the heterogeneity of VLBW preterm infants, their nutrition tolerance and neonatal pathologies, all nutrition support must be individualized for individual infants. This focus reinforces the need for the expertise of neonatal RDNs. These recommendations have been reviewed by the workgroup, guideline quality was assessed with the AGREE II tool, and guidelines were approved by the Academy's Council on Research.
Thureen PJ. Measuring energy expenditure in preterm and unstable infants. J Pediatr. 2003;142 (4):366-367
Enteral Nutrition, Nutrition Support, VLBW Preterm Infants
This guideline is primarily intended for health care practitioners working with VLBW preterm infants and their families in developed nations..
To provide enteral nutrition recommendations for health care practitioners working with VLBW preterm infants and their families that address the controversies and gaps in nutrition care that will promote health, growth and development; and address health consequences associated with preterm birth.
- To provide evidence-based, specific, action statements regarding recommended enteral nutrition for VLBW preterm infants.
- To guide enteral nutrition recommendations for VLBW preterm infants that allows for patient-centered care, consideration of family preferences, and short- and long-term health, growth and development.
VLBW Preterm Infants
Target Population Description
Preterm infants less than or equal to 1,500g in developed nations.
Interventions and Practices Considered
This guideline includes enteral nutrition recommendations
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