Pediatric Academic Societies

A hot themed symposium during the Pediatric Academic Societies (PAS) 2021 Virtual Meeting will address the ongoing controversy and issues in premature infant nutrition.

After six years of interdisciplinary expert discussion and critical evidence review, the 2014 vision of developing evidence-based guidelines for the nutritional care of premature infants was realized. The Eunice Kennedy Shriver National Institute for Child Health and Human Development (NICHD) and the Academy of Nutrition and Dietetics (AND) initiated this multi-phase process that involved medical specialists, nutritionists and pharmacologists.

The first phase, Pre-B, addressed the existing need for evidence and research on clinical questions within four subject areas: 1) nutrient specifications for preterm infants, 2) clinical and practical problems with enteral feeding of preterm infants, 3) gastrointestinal and surgical problems and 4) current standards of infant nutrition. This phase was started in 2016 by Raiten et al. Published as “Working Group Reports: Assessment of Evidence in Support of Practical Guidelines for the Nutritional Supply of Premature Babies – the Pre-B Project”.

“The National Institutes for Health and the Academy of Nutrition and Dietetics recognized the need for evidence-based best practice guidelines for feeding very low birth weight infants,” said Sarah Taylor, MD, MSCR. “You initiated the Pre-B project to address the lack of guidelines for these infants born to premature or ‘pre’ full-time birth. This work included an initial collaborative effort to identify research needs and possible topics for systematic review. “

The second phase of this process is a systematic review of the literature led by the AND Evidence Analysis Center and includes an international working group of clinical and research experts who will now share the results of this extraordinary multidisciplinary effort.

Dr. Taylor added, “The second phase was a multidisciplinary panel of experts that carried out the systematic review and developed evidence-based recommendations. The Enteral Nutrition Expert Panel and Systematic Review led the panel to provide evidence-based, specific recommendations for infants of very low birth weight who should be fed fortified breast milk supplemented with the donor’s pasteurized breast milk when breast milk is not available. In addition, the panel made a specific recommendation for optimal protein supplementation for infants with very low birth weights. From this Pre-B project, the NIH developed a strategic research support plan that addresses the multitude of remaining questions that the current evidence does not answer. “

“The Academy of Nutrition and Dietetics provides evidence-based guidelines for life-cycle nutrition, but had no guidelines for infants of very low birth weight until the work of this panel of experts,” said Dr. Taylor. “The panel of experts was able to develop recommendations for the intake of breast milk, breast milk and protein. Most of the time, the panel of experts found that the available literature is very limited and much larger research is needed to determine the optimal composition of a very low birth weight diet. “

The session will focus on clinical issues where existing evidence conflicts with current clinical nutrition recommendations and where the expert working group has had greater difficulty in reaching consensus. Each presentation also describes areas where there is a lack of available data and therefore research should be prioritized.

Presentations include:

  • The services and processes of NICHD Pre-B and the Evidence Analysis Center of the Academy for Nutrition and Dietetics; Moderator: Sharon Groh-Wargo, PhD, RDN – MetroHealth Medical Center
  • Very Little Childhood Protein Requirement: Realizing How Evidence Is Different From Experience; Moderator: Dr. Sarah Taylor, MSCR – Yale University Medical School
  • Energy and especially fat sources for premature babies: How is a seemingly fundamental question so complicated ?; Moderator: Dr. med. Camilia R. Martin, MS – Harvard Medical School / Beth Israel Deaconess Medical Center
  • The complex relationship between milk type and outcomes in very low birth weight premature infants; Moderator: Ian Griffin, MD, MA – New Jersey Biomedical Research Institute
  • Does the evidence support current clinical definitions of “extrauterine growth restriction” and “postnatal growth failure”? Moderator: Tanis Fenton, PhD, RD – University of Calgary

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