Anemia of Prematurity - Portal Neonatal

Energy
ENTERAL NUTRITION MANAGEMENT Section 8 of 11
• With enteral nutrition, human milk and standard infant formulas (20 cal/oz) provide 67
cal/100 mL. In general, human milk is the preferred source of enteral nutrition because of its
trophic and immunologic properties. Evidence is substantial that necrotizing enterocolitis is
lower in preterm infants fed with breast milk.
• Higher caloric densities include 22 cal/oz and 24 cal/oz formulas. Formulas with caloric
densities higher than 24 cal/oz should be used with caution, as they often have a very high
renal solute load and can lead to dehydration.
Carbohydrate
Fat
• Lactose is the carbohydrate source in human milk and in most standard formulas given to
term infants. Lactose provides 40-45% of the energy.
• In preterm infant formulas, lactose provides 50% of the carbohydrates and glucose
polymers provide 50%. This is because of the lower intestinal lactase levels and relatively
higher intestinal glycosidase levels in premature infants. The use of glucose polymers
(rather than monosaccharides or disaccharides) also helps maintain a lower osmolality.
• Soy and lactose-free formulas use sucrose, maltodextrins, and glucose polymers as the
carbohydrate sources.
• With enteral nutrition, approximately 50% of the energy is derived from fat. If more than 60%
of the energy is derived from fat, risk of ketosis is increased.
• Medium-chain triglycerides can be absorbed without pancreatic lipase or bile salt
emulsification. As a result, preterm infant formulas have a higher percentage of fat supplied
as medium-chain triglycerides.
Protein
• Protein requirements of 1.8-2.2 g/kg/d are readily provided to term infants by human milk
and standard infant formulas.
• Preterm infant formulas have a higher protein content to allow delivery of the necessary 3-
3.5 g/kg/d.
Minerals, vitamins, and trace elements
• Calcium, phosphorous, and magnesium
o During the third trimester, accretion rates for calcium (120-150 mg/kg/d) and
phosphorous (75-85 mg/kg/d) are higher than rates that can be provided in
premature infants receiving human milk. As a result, a human milk fortifier is
essential, and premature infants fed human milk must receive supplementation to
minimize the risk of osteopenia of prematurity.
o Premature infant formulas have a much higher concentration of these minerals,
which helps approximate the third trimester accretion rates in infants receiving these
formulas.
o Human milk and term and premature infant formulas all provide amounts of
magnesium adequate to meeting an infant's nutritional requirements if the infant is
receiving at least 100 cal/kg/d.