Patient management and principles of nutritional therapy in premature infants at the pediatric department
DOI: 10.32364/2618-8430-2024-7-1-10
L.A. Fedorova
St. Petersburg State Pediatric Medical University, St. Petersburg, Russian Federation
The advancement of perinatal care and neonatal technologies has led to an increase in the premature infant survival rate, including those with very low (birth weight less than 1500 g) and extremely low birth weight (birth weight less than 1000 g). At the same time, multiple organ dysfunction syndrome and a number of chronic diseases, that worsen the future life quality, form in premature infants in the neonatal period. Such diseases in premature infants as bronchopulmonary dysplasia, cerebral ischemia, intraventricular hemorrhages, retinopathy of prematurity, hearing disorders are accompanied by early and long-term complications and require multidisciplinary specialized care at all stages of child development. The disability risk in extremely premature infants reaches 50% and largely depends not only on therapeutic measures in the neonatal period but also on medical and rehabilitation care in infancy. The premature infant management after hospital discharge at the pediatric department is the most important stage of nursing, which continues after two in-patient stages (Intensive Care Unit and Department of Pathology of Premature Infants).
Keywords: premature infants, extremely low birth weight, very low birth weight, intraventricular hemorrhages, periventricular leukomalacia, bronchopulmonary dysplasia, cerebral palsy, nutritional therapy, formula for premature infants, pediatric department, outpatient follow-up stage.
For citation: Fedorova L.A. Patient management and principles of nutritional therapy in premature infants at the pediatric department. Russian Journal of Woman and Child Health. 2024;7(1):64–70 (in Russ.). DOI: 10.32364/2618-8430-2024-7-1-10.
About the author:
Larisa A. Fedorova — C. Sc. (Med.), Associate Professor of the Department of Neonatology with Faculty of Neurology and Obstetrics-Gynecology, St. Petersburg State Pediatric Medical University; 2, Litovskaya str., St. Petersburg, 194044, Russian Federation; ORCID iD 0000-0001-9747-762X.
Contact information: Larisa A. Fedorova, e-mail: arslarissa@rambler.ru.
Financial Disclosure: the author has no financial or property interest in any material or method mentioned.
There is no conflict of interest.
Received 04.12.2023.
Revised 25.12.2023.
Accepted 29.01.2024.
2. Bell E.F., Hintz S.R. Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network. Mortality, In-Hospital Morbidity, Care Practices, and 2-Year Outcomes for Extremely Preterm Infants in the US, 2013-2018. JAMA. 2022;327(3):248–263. DOI: 10.1001/jama.2021.23580.
3. Jarjour I.T. Neurodevelopmental outcome after extreme prematurity: a review of the literature. Pediatr Neurol. 2015;52(2):143–152. DOI: 10.1016/j.pediatrneurol.2014.10.027.
4. Kono Y., Yonemoto N., Nakanishi H. et al. Changes in survival and neurodevelopmental outcomes of infants born at <25 weeks' gestation: a retrospective observational study in tertiary centres in Japan. BMJ Paediatr Open. 2018;2(1):e000211. DOI: 10.1136/bmjpo-2017-000211.
5. Бронхолегочная дисплазия. Монография. Под ред. Овсянникова Д.Ю., Геппе Н.А., Малахова А.Б., Дегтярева Д.Н. М.; 2020. [Bronchopulmonary dysplasia. Ovsyannikov D.Yu., Geppe N.A., Malakhov A.B, Degtyarev D.N., eds. M.; 2020 (in Russ.)].
6. Сахарова Е.С., Кешишян Е.С., Алямовская Г.А. Неврологические исходы у недоношенных детей к трехлетнему возрасту. Медицинский совет. 2015;1:50–53. [Sakharova Ye.S., Keshishyan Ye.S., Alyamovskaya G.A. Neurological outcomes in premature infants by the age of three. Meditsinskiy sovet. 2015;1:50–53 (in Russ.)].
7. Федорова Л.А., Моисеева К.Е. Катамнез недоношенных детей. Детская медицина Северо-Запада. 2020;8(1):354–355. [Fedorova L.A., Moiseyeva K.Ye. Catamnesis of premature babies. Detskaya meditsina Severo-Zapada. 2020;8(1):354–355 (in Russ.)].
8. Кешинян Е.С., Беляева И.А., Петрова А.С. и др. Формирование системы динамического наблюдения за детьми, рожденными раньше срока, как важная стратегия по снижению инвалидности и улучшения качества их жизни. Педиатрия. Журнал им. Г.Н. Сперанского. 2023;102(1):12–17. DOI: 10.24110/0031-403X-2023-102-1-12-17. [Keshishyan E.S, Belyaeva I.A., Petrova A.S. et al. System of dynamic follow up of premature newborns as an important strategy to reduce disability and improve their quality of life. Pediatria n.a. G.N. Speransky. 2023;102(1):12–17 (in Russ.)]. DOI: 10.24110/0031-403X-2023-102-1-12-17.
9. Volpe J.J. Neurology of the Newborn. Philadelphia: Saunders; 2001.
10. Malavolti A.M., Bassler D., Arlettaz-Mieth R. et al. Bronchopulmonary dysplasia-impact of severity and timing of diagnosis on neurodevelopment of preterm infants: a retrospective cohort study. BMJ Paediatr Open. 2018;2(1):e000165. DOI: 10.1136/bmjpo-2017-000165.
11. Twilhaar E.S., Wade R.M., de Kieviet J.F. et al. Cognitive Outcomes of Children Born Extremely or Very Preterm Since the 1990s and Associated Risk Factors: A Meta-analysis and Meta-regression. JAMA Pediatr. 2018;172(4):361–367. DOI: 10.1001/jamapediatrics.2017.5323.
12. Неонатальная пульмонология: Монография. Под ред. Овсянникова Д.Ю. М.; 2022. [Neonatal pulmonology: Monograph. Ovsyannikov D.Yu., ed. M.; 2022 (in Russ.)].
13. Федорова Л.А. Неврологические исходы критических состояний у недоношенных детей с очень низкой и экстремально низкой массой тела при рождении: автореф. дис. … канд. мед. наук. СПб.; 2003. [Fodorova L.A. Neurological outcomes of critical conditions in premature infants with very low and extremely low birth weight: thesis. SPb.; 2003 (in Russ.)].
14. Biniwale M.A., Ehrenkranz R.A. The role of nutrition in the prevention and management of bronchopulmonary dysplasia. Semin Perinatol. 2006;30(4):200–208. DOI: 10.1053/j.semperi.2006.05.007.
15. Lapillonne A. Feeding the Preterm Infant after Discharge. In: Nutritional Care of Preterm Infants: Scientific Basis and Practical Guidelines. Koletzko B., Poindexter B., Uauy R., eds. Vol. 110. World Review of Nutrition and Dietetics. Basel: Karger. 2014:264–277.
16. Schneider J., Fischer Fumeaux C.J., Duerden E.G. et al. Nutrient Intake in the First Two Weeks of Life and Brain Growth in Preterm Neonates. Pediatrics. 2018;141(3):e20172169. DOI: 10.1542/peds.2017-2169.
17. Penagini F., Mameli C., Fabiano V. et al. Dietary Intakes and Nutritional Issues in Neurologically Impaired Children. Nutrients. 2015;7(11):9400–9415. DOI: 10.3390/nu7115469.
18. Завьялова А.Н. Питание детей с неврологической патологией. Медицина: теория и практика. 2019;4(1):42–51. [Zav'yalova A.N. Nutrition in neurologically impaired children. Medicine: theory and practice. 2019;4(1):42–51 (in Russ.)].
19. Овсянников Д.Ю. Система оказания медицинской помощи детям, страдающим бронхолегочной дисплазией: Руководство для практикующих врачей. Под ред. Кузьменко Л.Г. М.: МДВ; 2010. [Ovsyannikov D.Yu. System of providing medical care to children suffering from bronchopulmonary dysplasia: A guide for practitioners. Kuzmenko L.G., ed. M.: MDV; 2010 (in Russ.)].
20. Федорова Л.А., Софронова Л.Н., Иова А.С. и др. Ведение недоношенных детей после выписки из стационара (3-й этап выхаживания). Методические рекомендации. М.: Редакция журнала StatusPraesens; 2023. [Fodorova L.A., Sofronova L.N., Iova A.S. et al. Management of premature babies after discharge from the hospital (3rd stage of nursing). Guidelines. M.: Redaktsiya zhurnala StatusPraesens; 2023 (in Russ.)].
21. Higgins R.D., Jobe A.H., Koso-Thomas M. et al. Bronchopulmonary Dysplasia: Executive Summary of a Workshop. J Pediatr. 2018;197:300–308. DOI: 10.1016/j.jpeds.2018.01.043.
22. Narayan O., Bentley A., Mowbray K. et al. Updated cost-effectiveness analysis of palivizumab (Synagis) for the prophylaxis of respiratory syncytial virus in infant populations in the UK. J Med Econ. 2020;23(12):1640–1652. DOI: 10.1080/13696998.2020.1836923.
23. Пальчик А.Б., Понятишин А.Е., Федорова Л.А. Неврология недоношенных детей. М.: МЕДпресс; 2021. [Pal'chik A.B., Ponyatishin A.Ye., Fodorova L.A. Neurology of premature infants. M.: MEDpress; 2021 (in Russ.)].
24. Внутрижелудочковые кровоизлияния у недоношенных новорожденных. Основы персонализированной медицинской помощи: Учебное пособие. Под ред. Иова А.С. СПб.: СпецЛит; 2020. [Intraventricular hemorrhages in premature newborns. Basics of personalized medical care: Textbook. Iova A.S., ed. SPb.: SpetsLit; 2020 (in Russ.)].
25. Перинатальная нейрохирургия. Основы оптимальной медицинской помощи. Под ред. Иова А.С. СПб.: ООО «Человек»; 2015. [Perinatal neurosurgery. Fundamentals of optimal medical care. Iova A.S., ed. SPb.: OOO "Chelovek"; 2015 (in Russ.)].
26. Kolnik N., Strauss T., Globus O. et al. Risk factors for periventricular echodensities and outcomes in preterm infants. J Matern Fetal Neonatal Med. 2017;30(4):397–401. DOI: 10.1080/14767058.2016.1174684.
27. Falahati S., Breu M., Waickman A.T. et al. Ischemia-induced neuroinflammation is associated with disrupted development of oligodendrocyte progenitors in a model of periventricular leukomalacia. Dev Neurosci. 2013;35(2-3):182–186. DOI: 10.1159/000346682.
28. Embleton N.D., Jennifer Moltu S., Lapillonne A. et al. Enteral Nutrition in Preterm Infants (2022): A Position Paper From the ESPGHAN Committee on Nutrition and Invited Experts. J Pediatr Gastroenterol Nutr. 2023;76(2):248–268. DOI: 10.1097/MPG.0000000000003642.
29. Ericson J., Flacking R., Hellström-Westas L., Eriksson M. Changes in the prevalence of breast feeding in preterm infants discharged from neonatal units: a register study over 10 years. BMJ Open. 2016;6(12):e012900. DOI: 10.1136/bmjopen-2016-012900.
30. Carver J.D., Wu P.Y., Hall R.T. et al. Growth of preterm infants fed nutrient-enriched or term formula after hospital discharge. Pediatrics. 2001;107(4):683–689. DOI: 10.1542/peds.107.4.683.
31. O'Connor D.L., Hall R., Adamkin D. et al. Growth and development in preterm infants fed long-chain polyunsaturated fatty acids: a prospective, randomized controlled trial. Pediatrics. 2001;108(2):359–371. DOI: 10.1542/peds.108.2.359.
32. Marriage B.J., Buck R.H., Goehring K.C. et al. Infants Fed a Lower Calorie Formula With 2'FL Show Growth and 2'FL Uptake Like Breast-Fed Infants. J Pediatr Gastroenterol Nutr. 2015;61(6):649–658. DOI: 10.1097/MPG.0000000000000889.
33. Reverri E., Devitt A., Kajzer J. et al. Review of the Clinical Experiences of Feeding Infants Formula Containing the Human Milk Oligosaccharide 2'-Fucosyllactose. Nutrients. 2018;10:1346. DOI: 10.3390/nu10101346.
34. Goehring K.C., Marriage B.J., Oliver J.S. et al. Similar to those that are breastfed, infants fed a formula containing 2'-fucosyllactose have lower inflammatory cytokines in a randomized controlled trial. J Nutr. 2016;146(12):2559–2566. DOI: 10.3945/jn.116.236919.

This work is licensed under a Creative Commons «Attribution» 4.0 License.
















