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  • Print publication year: 2010
  • Online publication date: February 2010

Chapter 9 - Comparison between preterm and term infants

from Section 2 - Nutritional regulation and requirements for lactation and infant growth


Placental nutrient transfer capacity increases over gestation by increased placental growth, primarily of membrane surface area, allowing for the increase in nutrient supply required for the growing fetus. Glucose is the primary energy substrate for the mammalian fetus and placenta. The fetus metabolizes glucose in several ways, including oxidation for energy requirements and as a carbon source for production of various macromolecules, such as glycogen, glycolytic products, proteins, and fatty acids. Total nitrogen concentration measurements have been used to estimate the rate of protein accretion in tissues, because most of the total nitrogen is represented by amino acid nitrogen uptake. The net uptake of amino acids by umbilical circulation through the placenta represents the dietary supply of amino acids for fetal growth and protein metabolism. The transport of fatty acids and other lipid substances across the placenta and the deposition of lipids in fetal adipose tissue are primarily late-gestation phenomena.


1. TsangRC, UauyR, KoletzkoB, and ZlotkinSH, Nutrition of the Preterm Infant: Scientific Basis and Practical Guidelines (Cincinnati, OH: Digital Educational Publishing, 2005).
2. MicheliJ-L, and SchutzY, Protein. In ed., TsangRC, LucasA, UauyR, and ZlotkinSH, Nutrition of the Preterm Infant: Scientific Basis and Practical Guidelines (New York: Caduceus Medical Publishers 1993), pp. 29–46.
3. PremjiSS, FentonTR, and SauveRS, Higher versus lower protein intake in formula-fed low birth weight infants. Cochrane Database Syst Rev (2006), 1:CD003959.
4. EhrenkranzRA, DusickAM, VohrBR, WrightLL, WrageLA, and PooleWK, Growth in the neonatal intensive care unit influences neurodevelopmental and growth outcomes of extremely low birth weight infants. Pediatrics (2006), 117:1253–61.
5. LucasA, MorleyR, and ColeTJ, Randomised trial of early diet in preterm babies and later intelligence quotient. BMJ (1998), 317:1481–7.
6. UthayaS, ThomasEL, HamiltonG, DoreCJ, BellJ, and ModiN, Altered adiposity after extremely preterm birth. Pediatr Res (2005), 57:211–15.
7. FewtrellMS, LucasA, ColeTJ, and WellsJC, Prematurity and reduced body fatness at 8–12 y of age. Am J Clin Nutr (2004), 80:436–40.
8. EmbletonNE, PangN, and CookeRJ, Postnatal malnutrition and growth retardation: an inevitable consequence of current recommendations in preterm infants?Pediatrics (2001), 107:270–3.
9. RigoJ, Protein, Amino acid and other nitrogen compounds. In: ed. TsangRC, UauyR, KoletzkoB, and ZlotkinSH, Nutrition of the Preterm Infant: Scientific Basis and Practical Guidelines (Cincinnati, OH: Digital Educational Publishing, 2005), pp. 45–80.
10. TysonJE, LaskyR, FloodD, MizeC, PiconeT, and PauleCL, Randomized trial of taurine supplementation for infants less than or equal to 1,300-gram birth weight: effect on auditory brainstem-evoked responses. Pediatrics (1989), 83:406–15.
11. WhartonBA, MorleyR, IsaacsEB, ColeTJ, and LucasA, Low plasma taurine and later neurodevelopment. Arch Dis Child Fetal Neonatal Ed (2004), 89:F497–8.
12. AminHJ, ZamoraSA, McMillanDD, FickGH, ButznerJD, ParsonsHG, and ScottRB, Arginine supplementation prevents necrotizing enterocolitis in the premature infant. J Pediatr (2002), 140:425–31.
13. ShahP and ShahV, Arginine supplementation for prevention of necrotising enterocolitis in preterm infants. Cochrane Database Syst Rev (2007), 3:CD004339.
14. LeitchCA and DenneSC, Energy. In: ed. TsangRC, UauyR, KoletzkoB, ZlotkinSH, Nutrition of the Preterm Infant: Scientific Basis and Practical Guidelines (Cincinnati, OH: Digital Educational Publishing, 2005), pp. 23–44.
15. CarnielliVP, LuijendijkIH, Van GoudoeverJB, SulkersEJ, BoerlageAA, DegenhartHJ, and SauerPJ, Structural position and amount of palmitic acid in infant formulas: effects on fat, fatty acid, and mineral balance. J Pediatr Gastroenterol Nutr (1996), 23:553–60.
16. SanGiovanniJP, Parra-CabreraS, ColditzGA, BerkeyCS, and DwyerJT, Meta-analysis of dietary essential fatty acids and long-chain polyunsaturated fatty acids as they relate to visual resolution acuity in healthy preterm infants. Pediatrics (2000), 105:1292–8.
17. SimmerK and PatoleS, Longchain polyunsaturated fatty acid supplementation in preterm infants. Cochrane Database Syst Rev (2004), 1:CD000375.
18. FewtrellMS, AbbottRA, KennedyK, SinghalA, MorleyR, CaineE, et al., Randomized, double-blind trial of long-chain polyunsaturated fatty acid supplementation with fish oil and borage oil in preterm infants. J Pediatr (2004), 144:471–9.
19. ClandininMT, Van AerdeJE, MerkelKL, HarrisCL, SpringerMA, HansenJW, et al., Growth and development of preterm infants fed infant formulas containing docosahexaenoic acid and arachidonic acid. J Pediatr (2005), 146:461–8.
20. Groh-WargoS, JacobsJ, AuestadN, O'ConnorDL, MooreJJ, and LernerE, Body composition in preterm infants who are fed long-chain polyunsaturated fatty acids: a prospective, randomized, controlled trial. Pediatr Res (2005), 57:712–18.
21. ForsythJS, WillattsP, AgostoniC, BissendenJ, CasaerP, and BoehmG, Long chain polyunsaturated fatty acid supplementation in infant formula and blood pressure in later childhood: follow up of a randomised controlled trial. BMJ (2003), 326:953.
22. FewtrellMS, Long-chain polyunsaturated fatty acids in early life: effects on multiple health outcomes. A critical review of current status, gaps and knowledge. Nestle Nutr Workshop Ser Pediatr Program (2006), 57:203–14.
23. AtkinsonSA and TsangRC, Calcium, magnesium, phosphorus and vitamin D. In ed. TsangRC, UauyR, KoletzkoB, and ZlotkinSH, Nutrition of the Preterm Infant: Scientific Basis and Practical Guidelines (Cincinnati, OH: Digital Educational Publishing, 2005), pp. 245–76.
24. FewtrellMS, PrenticeA, JonesSC, BishopNJ, StirlingD, BuffensteinR, et al. Bone mineralization and turnover in preterm infants at 8–12 years of age: the effect of early diet. J Bone Miner Res (1999), 14:810–20.
25. FewtrellMS, ColeTJ, BishopNJ, and LucasA, Neonatal factors predicting childhood height in preterm infants: evidence for a persisting effect of early metabolic bone disease?J Pediatr (2000), 137:668–73.
26. FrielJK, AndrewsWL, AzizK, KwaPG, LepageG, and L'AbbeMR, A randomized trial of two levels of iron supplementation and developmental outcome in low birth weight infants. J Pediatr (2001), 139:254–60.
27. SteinmacherJ, PohlandtF, BodeH, SanderS, KronM, and FranzAR, Randomized trial of early versus late enteral iron supplementation in infants with a birth weight of less than 1301 grams: neurocognitive development at 5.3 years’ corrected age. Pediatrics (2007), 120:538–46.
28. FrielJK, AndrewsWL, MatthewJD, LongDR, CornelAM, CoxM, et al., Zinc supplementation in very-low-birth-weight infants. J Pediatr Gastroenterol Nutr (1993), 17:97–104.
29. DarlowB and GrahamP, Vitamin A supplementation to prevent mortality and short and long-term morbidity in very low birthweight infants. Cochrane Database Syst Rev (2007), 4:CD000501.
30. BrionLP, BellEF, and RaghuveerTS, Vitamin E supplementation for prevention of morbidity and mortality in preterm infants. Cochrane Database Syst Rev (2003), 3/4:CD003665.
31. TysonJE and KennedyKA, Trophic feedings for parenterally fed infants. Cochrane Database Syst Rev (2005), 3:CD000504.
32. LucasA, MorleyR, ColeTJ, ListerG, and Leeson-PayneC, Breast milk and subsequent intelligence quotient in children born preterm. Lancet (1992), 339:261–4.
33. SinghalA, ColeTJ, and LucasA, Early nutrition in preterm infants and later blood pressure: two cohorts after randomised trials. Lancet (2001), 357:413–19.
34. SinghalA, ColeTJ, FewtrellM, and LucasA, Breastmilk feeding and lipoprotein profile in adolescents born preterm: follow-up of a prospective randomised study. Lancet (2004), 363:1571–8.
35. SinghalA and LucasA, Early origins of cardiovascular disease: is there a unifying hypothesis?Lancet (2004), 363:1642–5.
36. KuschelCA and HardingJE, Multicomponent fortified human milk for promoting growth in preterm infants. Cochrane Database Syst Rev (2004), 1/2:CD000343.
37. ArslanogluS, MoroGE, and ZieglerEE, Adjustable fortification of human milk fed to preterm infants: does it make a difference?J Perinatol (2006), 26:614–21.
38. GarzaC, JohnsonCA, HarristR, and NicholsBL, Effects of methods of collection and storage on nutrients in human milk. Early Hum Dev (1982), 6:295–303.
39. AtkinsonSA, The effects of gestational stage at delivery on human milk composition. In ed. JensenRG, Handbook of Milk Composition (San Diego, CA: Academic Press, 1995), pp. 222–37.
40. BoydCA, QuigleyMA, and BrocklehurstP, Donor breast milk versus infant formula for preterm infants: systematic review and meta-analysis. Arch Dis Child Fetal Neonatal Ed (2007), 92:F169–75.
41. SchanlerRJ, LauC, HurstNM, and SmithEO, Randomized trial of donor human milk versus preterm formula as substitutes for mothers’ own milk in the feeding of extremely premature infants. Pediatrics (2005), 116:400–6.
42. LucasA, GoreSM, ColeTJ, BamfordMF, DossetorJF, BarrI, et al., Multicentre trial on feeding low birthweight infants: effects of diet on early growth. Arch Dis Child (1984), 59:722–30.
43. LucasA, MorleyR, ColeTJ, GoreSM, LucasPJ, CrowleP, et al., Early diet in preterm babies and developmental status at 18 months. Lancet (1990), 335:1477–81.
44. FewtrellMS, Growth and nutrition after discharge. Semin Neonatol (2003), 8:169–76.
45. LucasA, KingF, and BishopNB, Postdischarge formula consumption in infants born preterm. Arch Dis Child (1992), 67:691–2.
46. KooWW and HockmanEM, Posthospital discharge feeding for preterm infants: effects of standard compared with enriched milk formula on growth, bone mass, and body composition. Am J Clin Nutr (2006), 84:1357–64.
47. LucasA, FewtrellMS, MorleyR, SinghalA, AbbottRA, IsaacsE, et al., Randomized trial of nutrient-enriched formula versus standard formula for postdischarge preterm infants. Pediatrics (2001), 108:703–11.
48. MarriottLD, FooteKD, BishopJA, KimberAC, and MorganJB, Weaning preterm infants: a randomised controlled trial. Arch Dis Child Fetal Neonatal Ed (2003), 88:F302–7.