From the Academy Evidence Analysis Center| Volume 122, ISSUE 1, P182-206, January 2022

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Very Low Birthweight Preterm Infants: A 2020 Evidence Analysis Center Evidence-Based Nutrition Practice Guideline

Published:April 02, 2021DOI:
      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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      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.


      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.


      S. Groh-Wargo is a senior nutritionist and professor, Departments of Nutrition and Pediatrics, Case Western Reserve University at MetroHealth Medical Center, Cleveland, OH.


      K. Gura is a manager, Clinical Research Program, Department of Pharmacy, Boston Children’s Hospital, Boston, MA.


      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.


      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.


      M. Rozga is a nutrition researcher, Academy of Nutrition and Dietetics, Evidence Analysis Center, Chicago, IL.


      L. Moloney is a nutrition researcher, Academy of Nutrition and Dietetics, Evidence Analysis Center, Chicago, IL.