Nutritional Management for Preterm Infants with Common Comorbidities: A Narrative Review

Abstract

The complications observed in preterm infants are largely attributable to underdeveloped organ systems and inadequate nutritional stores at birth. Insufficient nutritional support can further exacerbate persistent sequelae, such as bronchopulmonary dysplasia (BPD), metabolic bone disease of prematurity (MBDP), and retinopathy of prematurity (ROP). As a result, clinicians have collaborated to develop optimal nutrition strategies for preterm neonates. However, these clinical nutrition plans may be hindered by several factors, including fluid restrictions due to patent ductus arteriosus (PDA) and delayed enteral nutrition following necrotizing enterocolitis (NEC). Modified strategies for specific conditions can help prevent further deterioration, but inadequate nutritional support may limit organ growth and contribute to additional complications. Achieving an optimal balance between nutritional support and managing specific medical conditions varies across institutions. In addition to fluid balance and energy intake, supplementary nutrition-such as vitamins and probiotics-plays a crucial role in disease prevention. Drawing on recent evidence and our clinical experiences with neonatal nutritional strategies, this review article summarizes the specialized nutritional management required for preterm neonates with conditions such as BPD, NEC, MBDP, PDA, and ROP.

Keywords: enteral nutrition; extremely low birth weight infant; morbidities; nutrition; parenteral nutrition; preterm neonates; very low birth weight infant.

Figure 1

Principles of Nutritional Management for Preterm Infants and Key Focus Areas for Managing Comorbidities during the Postnatal Period. The minimal nutritional needs on the day of birth are as follows: Energy, 50–60 kcal/kg/day; glucose, 6–12 mg/kg/day; amino acids (A.A.), ≥1.5 g/kg/day; and lipids, 1.5 g/kg/day. For target growth, the nutritional goals are energy 100–120 kcal/kg/day, glucose 12–14 mg/kg/day, amino acids 2.5–3.5 g/kg/day, and lipids 3.5–4.0 g/kg/day, which should be achieved as soon as possible. Abbreviations: PN: parenteral nutrition; EN, enteral nutrition; HM, human milk; NEC, necrotizing enterocolitis; PMA, postmenstrual age; PDA, patent ductus arteriosus; MBDP, metabolic bone disease of prematurity; ROP, retinopathy of prematurity; LCPUFAs, long-chain polyunsaturated fatty acids; BPD, bronchopulmonary dysplasia.