Gaining and Growing: Assuring Nutritional Care of Preterm Infants in the Community

Nutritional Impact of Diseases of Prematurity

 Background
 Medical and Developmental Factors that May Impact Growth, Intake, and Nutrient Needs

Background

Advances in neonatal care, including respiratory management and nutritional support, have contributed to a dramatic increase in the survival of infants born prematurely, and of low birth weight. Those who survive to discharge represent a considerably diverse group of infants. The infant born at 33 weeks exposed to drugs in utero may have different needs and characteristics after discharge than the extremely low birth weight (ELBW) infant who goes home requiring continued oxygen therapy for BPD. Medical and developmental complications present at discharge or emerging in the post discharge period may further impact the needs and identify unique characteristics of individual infants.

Some infants will be discharged without any major medical complications related to prematurity. Some will have minor issues related to immaturity, which will resolve as they approach 40 weeks corrected age (CA). Others will have significant medical or neurological sequelae. Some of these complications may emerge or be diagnosed after discharge. Close follow-up with health-care providers, specialty clinics, and developmental assessment will facilitate identification and management of these emerging or ongoing sequelae.

Medical and Developmental Factors that May Impact Growth, Intake, and Nutrient Needs

Note: Definitions and comments about disease conditions are found on the acronyms and definitions page.

CONDITION

NUTRITIONAL CONSIDERATIONS

Respiratory

Bronchopulmonary dysplasia (BPD)

Link to more information on BPD and nutrition

Reactive airway disease (RAD)

May have increased energy needs and decreased intake during respiratory illness. Risk for drug-nutrient interactions

Visual or Hearing Impairment

 

Retinopathy of prematurity (ROP)
  • May have feeding difficulties secondary to alterations in giving and receiving feeding cues
  • May startle at beginning of feeds and have difficulties attaining state control for feeding

Gastrointestinal

 

Short Bowel Syndrome
  • Nutritional implications vary with extent and site of resection. May include the following:
    • Fat malabsorption
    • Fluid and electrolyte imbalance
    • Vitamin and mineral deficiencies

Cholestasis
  • Malabsorption of long chain fats
  • Fat soluble vitamin deficiencies
  • Possible water soluble and mineral deficiencies
  • Growth failure

Gastroesopageal Reflux

Cardiovascular

 

Patent ductus arteriosis (PDA)
Congenital heart disease (CHD)
Cor Pulmonale

Apnea/Bradicardia/Cyanosis (ABC's)
  • May be related to feeding difficulties in some circumstances, i.e., difficulty coordinating suck-swallow-breathe, choking, possible sign of reflux

Renal

 

Nephrocalcinosis

  • Nutritional issues are related to degree of renal compromise
  • Acute complications include hematuria, pain, urinary tract infection
  • Persistent calcification may result in renal complications including hypertension and tubular dysfunction
  • Possible alterations in metabolism and nutritional status for: fluid and electrolytes, iron, calcium and phosphorus, and protein

Neurodevelopmental

 

Cerebral Palsy (CP)
Developmental delays
Motor immaturities
Learning disabilities

Nutritional

 

Anemia
Osteopenia
Failure to thrive		  

Small for Gestational Age (SGA)

 

Nutritional Assessment: Diseases of Prematurity Homepage
Gaining and Growing Homepage
More information contact: growing@uw.edu
Page reviewed: March 24, 2015