CHART 5-1 Examples of Conditions That Require Special Nutrition Management of the Neonate

• Prematurity (≤37 weeks' gestational age)a

• Very low birth weight (less than 1,500 g)a

• Low birth weight (less than 2,500 g)a

• Congenital anomalies of the gastrointestinal, renal, hepatic, cardiovascular, and central nervous systems

• Oral-facial anomalies, e.g., cleft palate

• Some congenital syndromes and genetic disorders, e.g., cystic fibrosis and Down syndrome

• Inborn errors of metabolism, e.g., phenylketonuria (PKU), galactosemia, or maple sugar urine disease (MSUD)

• Necrotizing enterocolitis

• Excessive or intractable diarrhea or vomiting

• Respiratory distress or apnea

• Chronic lung disease (bronchopulmonary dysplasia)

• Maternal diabetes mellitus

• Drug withdrawal

• Sepsis, peritonitis, meningitis

• Perinatal hypoxia

a The complexity of the nutritional concerns increases with decreasing length of gestation and birth weight.

the United States are high compared with the rates in other industrialized countries. These rates are especially high among disadvantaged groups; for example, LBW and VLBW rates for African-Americans were 12.7% and 2.7%, respectively, in 1987.1 The use of illegal drugs, especially cocaine, contributes to the problem of low birth weight2 and is associated with decreased head circumference.3

Although a majority of the infants who require intensive care are born preterm or very small, others are full-term infants with serious congenital birth defects or with any of a large number of other conditions that require special nutritional management (see Chart 5-1). The wide range of problems and the differences among infants make it essential to set individualized nutrition goals for each child.

Challenges That Confront Clinicians

Establishing goals for compromised neonates is often a complex process. 4,5 Nutritional goals for these infants may be substantially different from those for healthy full-term infants because they must be adjusted for



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