Neonatology pp 587-594 | Cite as

Nutritional Recommendations for the Very-Low-Birth-Weight Newborn

  • Ekhard E. ZieglerEmail author
Reference work entry


To ensure uninterrupted growth and development of the prematurely born infant, all nutrients must be provided in the necessary amounts at all times. Delivery of nutrients meets with a variety of obstacles in very low birth weight (VLBW) infants, which is why VLBW infants frequently receive less than the required amounts of nutrients. As a consequence they often fail to grow like they would have in utero and, more importantly, suffer impairment of their neurocognitive development. The main obstacles to delivery of nutrients historically have been concerns regarding presumed risks attendant to the administration of nutrients. Recent years have seen a gradual dissipation of these concerns as scientific evidence of the safety of providing nutrients has accumulated. This reassessment of the risks of nutrient administration has nearly been completed in the area of parenteral nutrition but is an ongoing process in the area of enteral nutrition. The more realistic assessment of risks, together with a desire to prevent postnatal growth failure and thereby minimize the risk of impaired neurocognitive impairment, has led to more aggressive regimens of nutrient administration.


  1. Arslanoglu S, Moro GE, Ziegler EE (2006) Adjustable fortification of human milk fed to preterm infants: does it make a difference? J Perinatol 26:614–621, PubMed CrossRefCrossRefGoogle Scholar
  2. Chauhan M, Henderson G, McGuire W (2008) Enteral feeding for very low birth weight infants: reducing the risk of necrotising enterocolitis. Arch Dis Child Fetal Neonatal Ed 93:F162–F166, CrossRefCrossRefGoogle Scholar
  3. Committee on Nutrition, American Academy of Pediatrics (1985) Nutritional needs of low-birth-weight infants. Pediatrics 75:976–986Google Scholar
  4. DeMarie MP, Hoffenberg A, Biggerstaff SLB et al (1999) Determinants of energy expenditure in ventilated preterm infants. J Perinat Med 27:465–472CrossRefGoogle Scholar
  5. Ehrenkranz RA, Dusick AM, Vohr BR et al (2006) Growth in the neonatal intensive care unit influences neurodevelopmental and growth outcomes of extremely low birth weight infants. Pediatrics 117:1253–1261, PubMed CrossRefCrossRefGoogle Scholar
  6. Forbes GB (1987) Human body composition. Springer-Verlag, New York, pp 101–124, CrossRefGoogle Scholar
  7. Forbes G (1989) Nutritional adequacy of human breast milk for prematurely born infants. In: Lebenthal E (ed) Textbook of gastroenterology and nutrition in infancy. Raven Press, New York, pp 27–34Google Scholar
  8. Kashyap S, Forsyth M, Zucker C et al (1986) Effects of varying protein and energy intakes on growth and metabolic response in low birth weight infants. J Pediatr 108:955–963, PubMed CrossRefCrossRefGoogle Scholar
  9. Kashyap S, Schulze KF, Forsyth M et al (1988) Growth, nutrient retention, and metabolic response of low birth weight infants fed varying intakes of protein and energy. J Pediatr 113:713–721, PubMed CrossRefCrossRefGoogle Scholar
  10. Kashyap S, Schulze KF, Forsyth M et al (1990) Growth, nutrient retention, and metabolic response of low-birth-weight infants fed supplemented and unsupplemented preterm human milk. Am J Clin Nutr 52:254–262CrossRefGoogle Scholar
  11. Koletzko B, Poindexter B, Uauy R (eds) (2014) Nutritional care of preterm infants. Karger, BaselGoogle Scholar
  12. Kramer MS, Platt RW, Wen SW et al (2001) A new and improved population-based Canadian reference for birth weight for gestational age. Pediatrics 108:1–7, CrossRefCrossRefGoogle Scholar
  13. Micheli JL, Schutz Y, Jequier E (1992) Protein metabolism of the newborn. In: Polin RA, Fox WW (eds) Fetal and neonatal physiology. Saunders, Philadelphia, pp 462–472Google Scholar
  14. Miller M, Vaidya R, Rastogi D, Bhutada A, Rastogi S (2014) From parenteral to enteral nutrition: a nutrition-based approach for evaluation of postnatal growth failure in preterm infants. J Parenter Enteral Nutr 38:489–497CrossRefGoogle Scholar
  15. Olhager E, Forsum E (2003) Total energy expenditure, body composition and weight gain in moderately preterm and full-term infants at term postconceptional age. Acta Paediatr 92:1327–1334, PubMed CrossRefCrossRefGoogle Scholar
  16. Polberger S, Räihä NCR, Juvonen P et al (1999) Individualized protein fortification of human milk for preterm infants: comparison of ultrafiltrated human milk protein and a bovine whey fortifier. JPGN 29:332–338, PubMedPubMedGoogle Scholar
  17. Rigo J (2005) Protein, amino acid and other nitrogen compounds. In: Tsang RC, Uauy R, Koletzko B, Zlotkin S (eds) Nutrition of the preterm infant, 2nd edn. Digital Educational Publishing, CincinnatiGoogle Scholar
  18. Rivera JA, Bell EF, Bier DM (1993) Effect of intravenous amino acids on protein metabolism of preterm infants during the first three days of life. Pediatr Res 33:106–111, PubMed CrossRefCrossRefGoogle Scholar
  19. Ronnestad A, Abrahamson TG, Medbo S et al (2005) Septicemia in the first week of life in a Norwegian national cohort of extremely premature infants. Pediatrics 115:e262–e268, PubMed CrossRefCrossRefGoogle Scholar
  20. Saini J, Macmahon P, Morgan JB et al (1989) Early parenteral feeding of amino acids. Arch Dis Child 64:1362–1366, PubMed CrossRefCrossRefGoogle Scholar
  21. Singhal A, Fewtrell M, Cole TJ, Lucas A (2003) Low nutrient intake and early growth for later insulin resistance in adolescents born preterm. Lancet 361:1089–1097, PubMed CrossRefCrossRefGoogle Scholar
  22. Snyderman SE, Boyer A, Kogut MD et al (1969) The protein requirement of the premature infant. I. The effect of protein intake on the retention of nitrogen. J Pediatr 74:872–880, PubMed CrossRefCrossRefGoogle Scholar
  23. Sparks JW (1984) Human intrauterine growth and nutrient accretion. Semin Perinatol 8:74–93, PubMedPubMedGoogle Scholar
  24. te Braake FWJ, van den Akker CHP, Wattimena DJL et al (2005) Amino acid administration to premature infants directly after birth. J Pediatr 147:457–461, CrossRefCrossRefGoogle Scholar
  25. van Goudoever JB, Vlaardingerbroek H, van den Akker C, de Groof F, van der Schoor SRD (2014) Amino acids and proteins. In: Koletzko B, Poindexter B, Uauy R (eds) Nutritional care of preterm infants. Karger, Basel, pp 49–63CrossRefGoogle Scholar
  26. Ziegler EE (1986) Protein requirements of preterm infants. In: Fomon SJ, Heird WC (eds) Energy and protein needs during in-fancy. Academic, New York, pp 69–85Google Scholar
  27. Ziegler EE (2005) Nutrition of SGA/IUGR newborn infants. Minerva Pediatr 57(Suppl 1):16–18Google Scholar
  28. Ziegler EE, O’Donnell AM, Nelson SE et al (1976) Body composition of the reference fetus. Growth 40:329–341, PubMedGoogle Scholar

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© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of PediatricsUniversity of IowaIowa CityUSA

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