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Effects of Total Enteral Nutrition on Early Growth, Immunity & Neuronal Development of Preterm Infants

Published in Nutrients, August 2021

 OPEN ACCESS  view online here

As the survival of pre-term infants increases, it is essential to understand their unique nutritional requirements. They have insufficient nutrient stores at birth and therefore nutritional supplementation is essential for growth, neuro-development and to improve their immune status. This review by Hossain et al highlights the needs of total enteral nutrition and explores the macro- and micro- nutritional requirements of pre-term infants.

The review initially looks at colostrum, human milk and human milk fortification. Colostrum is rich in immune-protective components, however exposure to colostrum may not always be possible because of the infant’s vulnerable health condition. Human milk (breast milk) contains a collection of beneficial components making this the gold standard for both full term and preterm infants. As preterm infants miss nutrition from their mother in the 3rd trimester, it is essential to supplement breast milk with additional nutrients to meet nutritional requirements. Typically breast milk supplementation with protein, carbohydrate, fats, minerals and vitamins is required, or if not possible, a preterm formula that contains all the essential elements is a suitable alternative. Human milk fortifiers (HMF) contain macronutrients as well as minerals and vitamins are available in powder or liquid form. Requirements are dependent on gestational age and the clinical condition of the preterm infant and there are formulas to assess requirements (see Table 1).

The review then goes on to specifically address the nutritional requirements of:

-Macronutrients: Protein; Fat; Carbohydrate

-Mineral requirements: Calcium and Phosphorous; Magnesium; Sodium; Potassium; Iron

-Trace Mineral Requirements: Zinc; Copper; Selenium; Manganese; Chromium; Molybdenum; Iodine

-Vitamins: D; A; E; K

The authors conclude with 4 clinical points they consider to be useful and summarise the findings of the review. Given that this is just 8 pages, it provides a succinct review of the key areas relevant to the nutritional management of preterm infants.