Infantile cortical hyperostosis associated with thrombocythemia. Clinical and hematological findings
Esposito, L.; Celentano, R.
La Pediatria 85(2): 237-257
1977
ISSN/ISBN: 0031-3890 PMID: 333369 Document Number: 3769
The optimal diet for the low-birth-weight infant may be defined as one that supports a rate of growth approximating that of the third trimester of intrauterine life, without imposing stress on the developing metabolic or excretory systems. Cell division and growth of all tissues in the infant should proceed at a rapid rate; undue delay in the resumption of growth may have serious and lasting consequences. The attainment of an adequate caloric intake is the primary requirement, and this may be facilitated by the feeding of formulas of caloric density greater than that of human milk. However, the feeding of this type of formula requires special attention to avoid too high an osmolar load and to provide sufficient water. The use of continuous intragastric or intrajejunal drip with formulas providing 67 or 81 kcal/dl also may be a safe and practical means of increasing caloric intake. Caloric intakes of about 120 kcal/kg/day in formula volumes of 150 to 200 ml/kg/day will support the desired weight gain in most infants. An appropriate requirement for protein equivalent to casein for the low-birth-weight infant would appear to fall in the range of 2.5 to 5.0 g/kg/day, or 2.25 to 4.5 g/100 kcal. A more precise statement of optimal protein quantity awaits the definition of optimal protein quality for low-birth-weight infants. Evidence has been accumulating that some amino acids considered nonessential for the normal infant are indispensable to low-birth-weight infants. Thus, the apparent normal growth of infants fed breast milk supplying 1.7 g of protein per kilogram of body weight may be caused in part by its distribution of amino acids. For the larger low-birth-weight infant, recommendations similar to those for the term infant, including the desirability of breast feeding, apply.11 Fat mixtures in formulas currently in use include unsaturated vegetable oils and/or medium chain triglycerides, which are well absorbed. Although good absorption of fat is important- not only for energy requirements but also to enhance the absorption of fat-soluble vitamins and certain minerals-other aspects must be considered in the selection of ideal formula fat compositions for low-birth-weight infants. The fatty acid composition of the diet influences the composition of body lipids, especially in low birth-weight infants who have meager stores of body fat. Fat mixtures should not be too saturated or too unsaturated. The occurrence of hemolytic anemia in low birth-weight infants has been related to the polyunsaturated fat, vitamin E, and iron content of the formula. The fortification of infant formulas with vitamin E, related to the polyunsaturated fatty acid content, is particularly important for the low-birth-weight infant because poor absorption of naturally occurring vitamin E by low-birth-weight infants makes them more susceptible to a deficiency. This is especially important if iron-supplemented formulas are used in the early weeks of life. Recent evidence indicates that some mineral requirements (e.g., calcium, sodium, copper) of the low-birth-weight infant may be greater per 100 kcal than for full-term infants. This suggests that slightly higher levels of these minerals be present in formulas for low-birth-weight infants than the minimum levels proposed by the Committee for full-term infants. Low body stores of vitamins, possible defects in absorption (particularly of fat-soluble vitamins), and low intakes of formula in the first weeks of life necessitate the use of vitamin supplements, even though a formula adequate for full-term infants is used. A single injection of vitamin K, at birth and daily oral supplements of vitamins A, C, D, E, and all the B group are recommended. The long-term effects of early nutrition are important and challenging aspects of infant nutrition. Early feeding of low-birth-weight infants entails a special responsibility because this is a crucial period of development when inadequacies, excesses, or imbalances are most likely to influence permanent changes. Long-term studies, still in progress, are attempting to relate feeding practices in the premature nursery to subsequent neurologic development, learning ability, behavioral characteristics, and mental development in general. Other possible pathologic consequences of improper early nutrition that are legitimate areas of concern for the pediatric nutritionist include atherosclerosis, obesity, hypertension, and renal disease.
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