Approaches to Growth Faltering

Throughout the chapters of this book, recommendations for nutrient intake are made with the overarching goal of optimizing health, growth, and development of the preterm infant. Over the past several decades, the importance of early nutritional support on growth and clinical outcomes has increasingly been recognized l. Indeed, nutrition is a modifiable factor that can mediate numerous morbidities of preterm birth, including many that are associated with poor growth. The widely agreed upon goals of early nutrition for preterm infants, particularly extremely low birth weight (ELBW: < 1,000 g) infants, are to "provide nutrients to approximate the rate of growth and composition of weight gain for a normal fetus of the same postmenstrual age and to maintain normal concentrations of blood and tissue nutrients" 2. Although this goal is widely quoted, the lack of reference values and the inability to measure tissue nutrient concentrations does little to add to our understanding of what goals we are trying to achieve. Further, it must be acknowledged that these recommendations are based on the knowledge of the impact of malnutrition on child development, with data in preterm neonates mostly arising from short-term outcomes or observational studies.