The National Institutes for Health and the Academy of Nutrition and Dietetics initiated
the “Pre-B Project” to address the lack of very low birth weight (VLBW) preterm infant
evidence-based nutrition practice guidelines. A scoping review and nine systematic
reviews on enteral nutrition interventions were conducted by a multidisciplinary Preterm
Panel. Recommendations were developed using the Academy’s Evidence Analysis Center
Process and the Grading of Recommendations Assessment, Development and Evaluation
(GRADE) Evidence-to-Decision framework. Literature was searched between January 1980
and November 2018. Recommendation strength was rated according to quality of supporting
evidence and other factors; each recommendation was categorized as imperative (applies
to entire target population) or conditional (applies to subset of population). For
VLBW preterm infants, evidence supported making specific recommendations for protein
intake (3.5–4.0 g/kg/day, fair quality, imperative); providing fortified mother's
milk when available (weak quality, imperative), or donor milk when mother's milk is
not available (weak quality, conditional). When donor milk is provided, growth should
be monitored and nutrition adjusted as appropriate (weak quality, conditional strength).
Current evidence does not suggest consistent benefits with enteral long-chain fatty
acid supplementation (fair quality, imperative). VLBW infants are a vulnerable population,
and evidence-based recommendations must rely on the most current and applicable evidence.
Although evidence was not available to support strong recommendations, this guideline
provides detailed guidance on enteral nutrition for VLBW infants based on best available
evidence to guide evidence-based practice.
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Biography
T. R. Fenton is a professor, Community Health Sciences, Institute of Public Health, Alberta Children’s Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada Nutrition Services, Alberta Health Services, Calgary, AB; and Canada Professor, Community Health Sciences, Nutrition Services, Alberta Health Services, Calgary, Canada.
Biography
I/ J. Griffin is a director, Clinical and Translational Research, Biomedical Research Institute of New Jersey, Cedar Knolls, NJ & Department of Pediatrics, Morristown Medical Center, Morristown, NJ.
Biography
S. Groh-Wargo is a senior nutritionist and professor, Departments of Nutrition and Pediatrics, Case Western Reserve University at MetroHealth Medical Center, Cleveland, OH.
Biography
K. Gura is a manager, Clinical Research Program, Department of Pharmacy, Boston Children’s Hospital, Boston, MA.
Biography
C. R. Martin is an associate professor of pediatrics, Harvard Medical School, and associate director, NICU, Department of Neonatology, Director for Cross-Disciplinary Research Partnerships, Division of Translational Research, Beth Israel Deaconess Medical Center, Boston, MA.
Biography
S. N. Taylor is Director of Clinical Research, Division of Neonatology, Associate Professor, Department of Pediatrics, Yale School of Medicine, 430 Congress Avenue, New Haven, CT.
Biography
M. Rozga is a nutrition researcher, Academy of Nutrition and Dietetics, Evidence Analysis Center, Chicago, IL.
Biography
L. Moloney is a nutrition researcher, Academy of Nutrition and Dietetics, Evidence Analysis Center, Chicago, IL.
Article info
Publication history
Published online: April 02, 2021
Accepted:
February 24,
2021
Received:
December 21,
2020
Footnotes
STATEMENT OF POTENTIAL CONFLICT OF INTEREST No potential conflict of interest was reported by the authors.
FUNDING/SUPPORT This work was supported by the Academy of Nutrition and Dietetics.
AUTHOR CONTRIBUTIONS: All authors were involved developing this systematic review from question formulation to evidence grading. LM, TF, and MR wrote the first draft of this manuscript, and all authors reviewed and commented on subsequent drafts of the manuscript.
Identification
Copyright
© 2022 by the Academy of Nutrition and Dietetics.
