Did you know that preterm and neonatal infants are more vulnerable to malnutrition than at any other time in their life? Before we get started with this newsletter, let’s clarify some definitions:
Preterm: an infant born at less than 37 weeks gestation.
Neonate: an infant born at 37 weeks or greater but who are less than 28 days old.
Some of the factors contributing to the increased malnutrition risk in this population include:
Reduced nutrient stores
Immature nutrient absorption
Delayed advancement in feeds
Dependence on health care providers
Period of high rapid growth and development
You may be aware of the Pediatric Malnutrition indicators developed by the Academy of Nutrition and Dietetics and the American Society for Parenteral and Enteral Nutrition in 2014. If not, check out our past blog: Pediatric Malnutrition – Dietitians Make a Difference for a quick rundown!
This same team developed the Preterm and Neonatal guidelines in 2018. If you haven’t seen them, you can access the full document here: https://www.sciencedirect.com/science/article/pii/S2212267217316295?via%3Dihub
First question – when do you use the Pediatric Malnutrition indicators vs. Preterm and Neonatal Malnutrition indicators?
The Pediatric Malnutrition Indicators are intended for use in infants aged beyond 37 weeks corrected gestation and older than age 30 days. The Preterm and Neonatal Malnutrition indicators are for use in hospital settings as well as post-discharge for infants who remain younger than 37 weeks gestation/postmenstrual age.
As the saying goes, a picture is worth a thousand words. Here’s a quick snapshot of the Preterm and Neonatal Malnutrition Indicators developed by ASPEN:
Access the full pdf chart here: http://www.nutritioncare.org/uploadedFiles/Documents/Malnutrition/Malnutrition%20Indicators%20in%20Preterm%20and%20Neonatal%20Populations%20Card.pdf
Next question – which information do you need to gather to use this table?
Your assessment should include: birth weight and length, weight and length at each visit and nutrient intake.
Primary indicators requiring 1 indicator:
-Decline in weight-for-age z score
-Weight gain velocity
Primary indicators requiring 2 or more indicators:
-Days to regain birth weight
-Linear growth velocity
-Decline in length-for age z score
*pay close attention to when each indicator can be used as some are not appropriate in the first 2 weeks of life or when the infant is critically ill
We know this table and indications might feel overwhelming. It’s one of those things that takes practice as an assessment tool. The more you use it, the easier it gets. There are quite a few skills involved in utilizing this correctly such as plotting growth on the correct curve, calculating z-scores and weight gain velocity along with determining estimated needs for this population. Each of these topics is a newsletter on its own! We’re working on it .
Have you been using the Preterm & Neonatal Malnutrition guidelines in your practice? Is this all new for you with a learning curve ahead?
We’d love to hear from you,
Julie and Charlene
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