Preterm infants face significant growth challenges due to high metabolic demands, limited nutrient reserves, poor temperature control, and prolonged illness. These challenges are prevalent in all neonatal intensive care units, irrespective of the level of resources available. In low- and middle-income countries (LMICs), preterm infant nutrition risk can be exacerbated by constrained tangible and human resources, making the provision of adequate nutrition even more difficult. In this article, we explore neonatal growth and nutrition in LMICs and identify key strategies that clinicians can adopt to optimize the use of available enteral and parenteral nutrition resources. We address the following approaches: (1) when and how to use alternative fortifiers if infant formula is cost-prohibitive, (2) strategies to optimize intravenous fluids in the absence of total parenteral nutrition, (3) nonfeeding interventions to optimize growth, and (4) discharge feeding strategies and ongoing growth assessments for extremely low-birth-weight infants. The findings of this article highlight the importance of tailored nutritional approaches, the need for innovative resource management, and the critical role of interdisciplinary collaboration in enhancing the care of preterm infants globally.
Gregory et al. (Sun,) studied this question.