Workshop Summary: Nutrition of the Extremely Low Birth Weight Infant

Abstract

Over the past decade many exciting advances have been made with regard to the survival, medical care, and outcome of extremely low birth weight (ELBW) infants (those who weigh <1000 g at birth). Yet the growth of these infants continues to lag considerably after birth.1 Furthermore, this postnatal lag of growth is related to long-term growth and neurodevelopmental delays at least through school age2–5 and, possibly, into adulthood.6 These major deficits define critical needs for further information about the nutritional requirements for growth of ELBW infants, how they should be fed, and whether improved growth and developmental outcomes can be achieved with earlier and more aggressive postnatal nutrition. To address these critical needs, a Workshop was sponsored by the National Institute of Child Health and Human Development in September 1997. This Workshop Summary, updated in December 1998, presents consensus views of the Workshop attendees about current information on the nutritional requirements of ELBW infants, how well these requirements are met by current feeding practices, and the extent to which current nutritional practices in the early postnatal period contribute to the generally poor outcome of these infants. The Summary concludes with recommendations for research to fill gaps in knowledge and resolve controversies in knowledge and current practice that should lead to improved nutrition, growth, and developmental outcome of ELBW infants. The premise of the Workshop was that optimal nutrition of ELBW infants should meet the unique and changing nutrient requirements of these infants and support growth that mimics normal fetal growth.7 Unfortunately, this goal is seldom met. On the one hand, extremely preterm birth results in seemingly insurmountable impediments to growth, including the stress of relatively frequent pathophysiologic events (eg, hypotension, hypoxia, acidosis, infection, surgical interventions), pharmacologic treatments (eg, corticosteroids) and physiologic immaturity (eg, limited intestinal motility). …