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APHA Scientific Session and Event Listing

William W. Hay, MD, Professor of Pediatrics (Neonatology), University of Colorado School of Medicine, Campus Box F441, Perinatal Bldg. 260, Aurora, CO 00000, 303-724-1600, mlavan@marchofdimes.com

The current goal for postnatal nutrition of very preterm infants is to meet the unique nutritional requirements of the growing human fetus and duplicate normal fetal growth and development. Normal fetal nutrition, therefore, should be a useful guide for designing postnatal nutritional strategies in very preterm infants who need to grow and develop outside the uterus. Normal fetal nutrition requires certain “nutrients” and growth promoting hormones that together support optimal fetal growth and development; these include oxygen, glucose, lipids, amino acids, and insulin. Most preterm infants, however, get too much oxygen and are fed more glucose and lipid and less protein than they need. They also do not have sufficient insulin production, while insulin action is increased in promoting energy storage, but decreased in promoting protein synthesis. Not surprisingly, therefore, very preterm infants remain relatively growth restricted at term gestational age, with a metabolic phenotype that encourages fat production and limits growth. Thus, they tend to have short stature even into childhood and adolescence, they have less than normal intellectual and developmental outcomes that could be due in part to nutritional deficiencies, and their growth restriction probably predisposes them to adult disorders of obesity, insulin resistance, and diabetes, particularly when overfed in infancy. Better understanding of the unique nutritional, metabolic, and growth requirements of the normally growing fetus and the very preterm infant once born are needed to determine optimal nutritional strategies for immediate metabolic needs, short term growth, and long term growth and developmental outcome of preterm infants.

Learning Objectives:

• To understand the nutrient substrate (glucose, amino acids, lipids) and anabolic hormone (insulin) requirements that produce normal rates of fetal growth and change in body composition, and how that information has been used to optimize postnatal growth of preterm infants that more closely approximates that of the normally growing, healthy fetus.

Presenting author's disclosure statement:

Any relevant financial relationships? No