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Interventional strategies to promote appropriate growth
So, Eckhart, when a baby is born with low birth weight can interutarine growth rates be achieved
when there is a critical period of the birth or will the baby fall behind?
What are neonatologists doing? The short answer is all babies lose weight, they lose weight immediately after birth.
and they continue to lose weight as they grow. We call it post natal growth failure.
or extrauterine growth failure and they fall off where they would of grown in the fetus.
Now we know that this growth failure is, in a dose-dependent fashion
associated with poor neurocognitive outcome. The more severe the growth failure
the worse the neurocognitive outcome at two years or even later on in life
and so let me finish because we know that all neonatologists strive
to prevent, or to ameliorate this growth failure but nobody has succeeded in making premature babies grow
exactly like the fetus nobody has
Now It is not only the quantity of protein and calories which you can give I assume that
a premature baby needs more calories and needs more proteins than a term baby
It is also the quality which is very important and I am coming to my question...
What is the role of mother's milk? Yes premature babies have much higher nutrient needs than full time babies
they need more protein especially and they need more minerals
and that is the main reason why mother's milk which is designed for full time babies
does not contain enough protein, enough calcium, enough phosphorus for the premature babies
and that is the reason why we add these nutrients we call it nutrient fortification
But the issue of providing nourishment to the premature baby is much more complicated
than that, it is complicated by the fact that the gastrointestinal tract of the premature infant is very
very immature at the beginning and we cannot rely on feeding the baby
for days and weeks. All we can do is put small amounts of food into the stomach of the baby
and wait until the gastrointestinal tract becomes mature so that it moves things forward
it absorbs things and during that time we have to provide nutrition parenterally
that means into the veins and that is something that is now widely practiced by all
neonatologists, not all do it in a satisfactory way but pretty much all neonatologists
provide parenteral nutrition and then go about stimulating the immature gastrointestinal tract
to the point where it can accept full nutrients
Last question, how long? The baby is not growing, the low birth weight infant reaches 4-5kgs
body weight, does it still have specific needs or are the needs then according to the term infant?
When the baby goes home, the baby typically weighs 2.5kgs
at that point the baby's needs are still higher than those of a full term baby that is why
we have special formulas for babies or when they go home breastfeeding
we still fortify the milk. But once they reach 5kgs grams we are pretty much sure
that the baby's needs are comparable to those of a full term baby.
OK thank you very much