Feeding the Preterm Neonate with Intra Uterine Growth Restriction

Intrauterine growth restriction (IUGR) is the failure to achieve the ge2 netically predetermined growth potential and may be caused by fetal, maternal, 3 placental, and external factors. IUGR is associated with significant perinatal mortal4 ity and morbidity and adverse long-term outcomes, in preterm, especially extremely 5 preterm infants with gestation under 28 weeks at birth. Optimal enteral feeding is 6 crucial in this population as suboptimal nutrition during a critical phase of postnatal 7 life is associated with a negative impact on long term neurodevelopment. However 8 enteral nutrition is a difficult issue in these infants considering the adverse effects of 9 chronic hypoxia on the fetal gastrointestinal tract, and the inherent susceptibility of 10 this high-risk population to a potentially devastating illness such as necrotising en11 terocolitis (NEC). Signs of feed intolerance such as abdominal distension, large/bile 12 stained gastric residuals are almost universal in the first week or two in extremely 13 preterm IUGR infants and are difficult to differentiate from early NEC. This is also 14 the period when suboptimal nutrition constitutes a nutritional emergency. Animal 15 data associate IUGR with reduced intestinal weight (proportionate to body weight), 16 length and wall thickness, and reduced villous height and crypt depth at the micro17 scopic level. Initial observations on a distinct gut colonization pattern may also be 18 relevant to the specific health hazards in this population. This chapter reviews the 19 current strategies for enteral feeding, and the potential long term adverse effects of 20 catch up growth (e.g., increased risk of obesity, hypertension and diabetes mellitus) 21 in the preterm infant with IUGR.