01 October 2003
Nutritional strategies in neonatal intensive care
Janusz Świetliński, Iwona Maruniak-ChudekMed Sci Monit 2003; 9(5): 60-60 :: ID: 428738
Abstract
Nutrition of neonates in intensive care (NICU)is aimed for the supply of energy ,protein and other elements required for growth and normal development. Intrauterine provision of nutrients in uncomplicated pregnancy, followed by breast feeding by own mother is recognized as the ideal, unattainable pattern of a properneonatal nutrition. The population of patients in NICU is mainly consisted of very low or extremely low birth weight premature infants or infants in metabolic stress: with multiorgan failure, SIRS, with birth trauma or after surgery. These newborns have very small energy reserves, but very often the natural enteral way of feeding is excluded or seriously limited. In the same time co-existing negative factors changed the metabolic processes for catabolism. Intensive care of such patients includes the optimal provision of nutrients in respect to way of supply ontents and amount, in order to reverse metabolism on anabolic pathway without causing injury. The strategy of care should be based on studies ’results on fetal and neonatal metabolism. Very high level of metabolic processes in fetal life is already acknowledged. The glucose supply is adequate to the energy needs, enables the fetus to keep blood glucose concentration on stable level around 50 mg/dl, with relatively low insulin concentration. Glucose consumption is reduced with the course of pregnancy. The third trimester of intrauterine life is the time for more pronounced role of lipids in energy production and at birth the body is consisted in 15%of fat (the highest value among all land mammals).The quantity and the quality of lipid sub- stances are crucial for cellular membranes development, especially in central nervous system and vessels and also signaling transmitters. Aminoacids intake, actively transported via placenta is high and exceeds amounts needed for fetal growth (the surpluses become the source of energy).Nutritional needs –especially of premature newborns -are not changed with the moment of birth and only few hours of starvation can be allowed. A sudden cut in energy supply leads to increase in protein degradation and drastic change for catabolic processes. The immediate, in a couple of hours after the labor, supplementation of essential nutrients,b followed in nextdays by any necessary -according to the clinical status modification, is fundamental in neonatal nutrition The alimentary strategies are based on the certitude that neonatal metabolic requirements are equal or higher than fetal. Sufficient amount of fluids, estimated on exact input –output evaluation and frequent body weighing, plays the key role in intensive care management. The next point is the initial glucose supply of 5 –7 mg per kilogram per minute, increased in reasonably short time with the respect to serum glycemia. Insulin drip administration should be very carefully considered, after failure of the other methods of reduction in glucose concentration (the increase in aminoacids provision, the decrease in glucose daily load)and after exclusion of acute phase of sepsis. Early (even on the first day of life)and high (up to 3 grams per kilogram per day) aminoacids supplementation controls not only a growth rate but also may positively influence endogenous insulin secretion. According to same novel results from the leading research centers, lipids can be initiated on the first day of life and achieve 3 grams per kilogram per day in the next 72 hours. Calcium, phosphorus, magnesium, similarly as vitamins and trace elements, should not be omitted in well-balanced nutrition, however their influence on metabolism in ill, unstable infants is not fully known. Enteral feeding is recommended parallel to parenteral nutrition, in amounts adjusted to the clinical status and by the mode most appropriate to patient ’s condition. Minimal trophic feeding with breast milk is usually well tolerated even in ELBW and ILBW. Not only basic components of breast milk are optimal for newborns, but also unique hormonal and immunological substances should not be neglected. Infant formulas –still being improved –are modeled on breast milk, also in immunonutrients.These last ones are not fully explored, but never the less seemed to be of high importance. The effects of early nutritional proceeding are stretched over time, which should be kept in mind while performing alimentary support to premature or ill newborns. Proper supply of nutrients allows overcoming current health instability and influences significantly survival of infants in meta- bolic stress. On the other hand, its longitudinal effects are imprinted on the quality of life in the following months and years.
Keywords: newborn, Intensive Care, total parenteral nutrition, Enteral Nutrition, Metabolism
Editorial
01 February 2023 : Editorial
Editorial: The XBB.1.5 (‘Kraken’) Subvariant of Omicron SARS-CoV-2 and its Rapid Global SpreadDOI: 10.12659/MSM.939580
Med Sci Monit 2023; 29:e939580
SARS-CoV-2/COVID-19
19 January 2023 : Clinical Research
Evaluation of Health-Related Quality of Life and Mental Health in 729 Medical Students in Indonesia During ...Med Sci Monit In Press; DOI: 10.12659/MSM.938892
19 January 2023 : Clinical Research
Determining the Impact of the COVID-19 Pandemic on Dental Care in the Serbian Adult Population: An Online Q...Med Sci Monit 2023; 29:e939238
27 December 2022 : Clinical Research
Effect of Physiotherapy to Correct Rounded Shoulder Posture in 30 Patients During the COVID-19 Pandemic in ...Med Sci Monit 2022; 28:e938926
10 December 2022 : Clinical Research
Retrospective Study to Identify Risk Factors for Severe Disease and Mortality Using the Modified Early Warn...Med Sci Monit 2022; 28:e938647
In Press
03 Feb 2023 : Clinical Research
Treatment of Gingival Recession Defects with Pouch and Tunnel Technique Using Connective Tissue Graft and L...Med Sci Monit In Press; DOI: 10.12659/MSM.938865
02 Feb 2023 : Clinical Research
Online Questionnaire-Based Study to Evaluate the Attitudes and Use of Rubber Dental Dams by Saudi Dental Pr...Med Sci Monit In Press; DOI: 10.12659/MSM.938672
02 Feb 2023 : Database Analysis
Prognostic-Related Biomarkers in Pancreatic Ductal Adenocarcinoma Correlating with Immune Infiltrates Based...Med Sci Monit In Press; DOI: 10.12659/MSM.938785
01 Feb 2023 : Clinical Research
Comparison of 3 Enzyme-Linked Immunoassay Methods to Evaluate Serum Concentrations of Infliximab and Antibo...Med Sci Monit In Press; DOI: 10.12659/MSM.939084
Most Viewed Current Articles
13 Nov 2021 : Clinical Research
Acceptance of COVID-19 Vaccination and Its Associated Factors Among Cancer Patients Attending the Oncology ...DOI :10.12659/MSM.932788
Med Sci Monit 2021; 27:e932788
30 Dec 2021 : Clinical Research
Retrospective Study of Outcomes and Hospitalization Rates of Patients in Italy with a Confirmed Diagnosis o...DOI :10.12659/MSM.935379
Med Sci Monit 2021; 27:e935379
08 Mar 2022 : Review article
A Review of the Potential Roles of Antioxidant and Anti-Inflammatory Pharmacological Approaches for the Man...DOI :10.12659/MSM.936292
Med Sci Monit 2022; 28:e936292
01 Jan 2022 : Editorial
Editorial: Current Status of Oral Antiviral Drug Treatments for SARS-CoV-2 Infection in Non-Hospitalized Pa...DOI :10.12659/MSM.935952
Med Sci Monit 2022; 28:e935952