Effects of Total Enteral Nutrition on Early Growth, Immunity, and Neuronal Development of Preterm Infants
Abstract
:1. Introduction
2. Oropharyngeal Colostrum
3. Human Milk
4. Human Milk Fortification
5. Protein
6. Fat
7. Carbohydrate
8. Mineral Requirements for Preterm Infants
8.1. Calcium and Phosphorus
8.2. Magnesium
8.3. Sodium
8.4. Potassium
8.5. Iron
9. Preterm Trace Mineral Requirements
9.1. Zinc
9.2. Copper
9.3. Selenium
9.4. Manganese
9.5. Chromium, Molybdenum, and Iodine
10. Recommendations Concerning Vitamins
10.1. Fat-Soluble Vitamins
Vitamin D
Vitamin A
Vitamin E
Vitamin K
11. Conclusions
- Oropharyngeal colostrum administration appears to be safe and promotes immunological maturation;
- HM can provide many essential elements for preterm infants; if it is not available, donor HM can be provided, even if it is not an equivalent to the own mother’s milk;
- Earlier feeding initiation, human milk fortification, and certain formulas appear to improve the growth and neurodevelopmental outcomes;
- Carbohydrate, protein, fat, minerals, trace minerals, and vitamins should be provided through PN or EN considering the requirements of preterm infants for their better growth and development.
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Body Weight (g) | 500–1000 | 1001–1500 | 1501–2000 |
---|---|---|---|
Weight gain of fetus (g/kg/day) | 19.0 | 17.4 | 16.4 |
Protein gain of fetus (g/kg/day) | 4.0 | 3.9 | 3.7 |
Energy (Kcal/kg/day) | 106 | 115 | 123 |
Protein/energy (g/100 kcal) | 3.8 | 3.4 | 3.0 |
Trace Minerals | Role | Deficiency Symptoms | ASPEN Recommended Dose for Preterm Infant (µg/kg/day) | ESPHAN Recommended Dose for Preterm Infant (µg/kg/day) |
---|---|---|---|---|
Zinc | Cofactor for >300 metalloenzymes; important for growth, cell differentiation, and the metabolism of proteins, carbohydrates, and lipids; plays a role in hormone structure, gastrointestinal (GI) development, immune function, and genetic transcription factors | Poor growth; weight loss; periorificial dermatitis; glossitis; increased susceptibility to infections; diarrhea | 300 | 400–500 |
Copper | Free radical scavengers-help protect cell membranes from oxidative damage; essential to the proper functioning of organs and metabolic processes | Hypochromic anemia resistant to iron; pancytopenia; poor wound healing; osteopenia; fractures | 20 | 40 |
Selenium | Free radical scavenger; antioxidant; can reduce the risk of sepsis; plays a role in thyroid hormone metabolism | Myocardial disorders; skeletal muscle disorders; erythrocyte macrocytosis; fingernail-bed abnormalities; pseudoalbinism; growth retardation; alopecia | 2 | 7 |
Manganese | Cofactor for several enzymes, including superoxide dismutase and pyruvate carboxylase | Affects mucopolysaccharide and lipopolysaccharide formation; impaired skeletal development and ataxia (animal models) | 1 | ≤1 |
Chromium | Important for macronutrient metabolism; enhances the action of insulin | Insulin-resistant hyperglycemia; glucose intolerance; weight loss; high plasma free fatty acid concentrations | 0.0006 | 0 |
Molybdenum | Required by 3 enzymatic systems: xanthine dehydrogenase/oxidase, aldehyde oxidase, and sulfite oxidase | Cardiac and neurologic symptoms, including tachycardia and coma; high blood levels of sulfite and urate | NG | 1 |
Iodine | Major component of thyroid hormones that regulate key biochemical reactions in energy and protein metabolism; necessary for growth, development, and maturation | Hypothyroidism; poor growth; poor neurodevelopment; cretinism; goiter | NG | 1–10 |
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Hossain, Z.; Qasem, W.A.; Friel, J.K.; Omri, A. Effects of Total Enteral Nutrition on Early Growth, Immunity, and Neuronal Development of Preterm Infants. Nutrients 2021, 13, 2755. https://doi.org/10.3390/nu13082755
Hossain Z, Qasem WA, Friel JK, Omri A. Effects of Total Enteral Nutrition on Early Growth, Immunity, and Neuronal Development of Preterm Infants. Nutrients. 2021; 13(8):2755. https://doi.org/10.3390/nu13082755
Chicago/Turabian StyleHossain, Zakir, Wafaa A Qasem, James K. Friel, and Abdelwahab Omri. 2021. "Effects of Total Enteral Nutrition on Early Growth, Immunity, and Neuronal Development of Preterm Infants" Nutrients 13, no. 8: 2755. https://doi.org/10.3390/nu13082755