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Nutritional Support 33
Table 6.6: Evidence-based research.
Title Feeding issues in preterm infants
Authors Cooke RJ, Embleton ND
Institution Ward 35, Leazes Wing, Royal Victoria Infirmary, Newcastle
upon Tyne, United Kingdom
Reference Arch Dis Child Fetal Neonatal Ed 2000; 83:F215–F218
Problem Ensuring that the nutritional intake of sick preterm infants
meets requirements for sustained growth.
Intervention Review of various practices to ascertain whether there are any
differences in outcomes among the different practices.
Comparison/ The relation between measurements of knee-heel and crown-
control heel length is not consistent, as shown in some studies. These
(quality of were thought to be the most sensitive indices of the adequacy
evidence) of nutrient intake. There is no benefit in feeding formula with
a protein/energy ration of 2.8 g per 100 kcal until term. Same
results are obtained with a similar P/E ration if the infants are fed
until between 3 to 9 corrected months.
Outcome/ Feeding practices in preterm infants vary quite widely among
effect special care baby units. Practices must be audited as a basis
for their continuance.
Historical Different studies over a period of time have arrived at different
significance/ conclusions.
comments

Key Summary Points
1. Preoperatively, most patients in most countries in Africa are 6. Enteral feeding is always preferred, offering fewer complications.
frankly malnourished or borderline malnourished, which has 7. Necessary baseline tests include serum electrolyte estimation,
implications for postoperative outcomes, including various serum protein levels, and liver function.
degrees of poor wound healing.
8. Attention to nutrition has to start in utero, with education
2. If surgery is elective, it is better to improve on nutritional dispelling any nutritional myths for pregnant women.
status preoperatively. This is the best opportunity to maximise
postoperative outcomes. 9. Nutrition in children younger than 5 years of age must ensure
adequate intake of calories, which will allow maximum growth
3. If surgery is emergent, supplemental nutrition should be offered of the individual as well as the required intake of minerals and
as soon as possible. vitamins to maximise their growth. Locally available foodstuffs
4. Patients undergoing surgery who will suffer long periods of ileus can be used for this.
postoperatively require careful planning for nutritional support. 10. Institutional policies must be developed to address ethical issues
5. Patients with high metabolic requirements postoperatively also in order to protect physicians.
require nutritional support.

References

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Gastroenterology 1995; 108(4):1280–1281. prescription and delivery according to their energy requirements?
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