Despite recent declines in infant mortality, the rates of low birthweight deliveries in the United States continue to be high. Part I of this volume defines the significance of the problems, presents current data on risk factors and etiology, and reviews recent state and national trends in the incidence of low birthweight among various groups. Part II describes the preventive approaches found most desirable and considers their costs. Research needs are discussed throughout the volume.
How to prevent and manage low birth weight Growth and nutrition during the fetal period and the first 24 months after birth are important determinants of development in early childhood. Optimal nutrition and health care of both the mother and infant during these first 1000 days of an infant's life are closely linked to growth, learning potential and neurodevelopment, in turn affecting long-term outcomes. Children with low birth weight do not only include premature babies, but also those with intrauterine growth restrictions who consequently have a very high risk of developing metabolic syndrome in the future. Epidemiology, epigenetic programming, the correct nutrition strategy and monitoring of outcomes are thus looked at carefully in this book. More specifically, two important nutritional issues are dealt with in depth: The first being the prevention of low birth weight, starting with the health of adolescent girls, through the pre-pregnancy and pregnancy stages and ending with lactation. The second point of focus concerns the nutritional follow-up and feeding opportunities in relation to dietary requirements of children with low birth weight.
The goal of nutritional management in VLBW and ELBW infants is the achievement of postnatal growth at a rate that approximates the intrauterine growth of a normal fetus at the same postconceptional age. In reality, however, growth lags considerably after birth; although non-nutritional factors are involved, nutrient deficiencies are critical in explaining delayed growth. This practical clinically-oriented pocketbook reviews and summarises all available clinical evidence. It enables the reader to implement parenteral or enteral feeding plans, with the goals of reducing postnatal weight loss, earlier return to birthweight, and improved catch-up growth. Both nutrient balance and growth and the impact on neurodevelopment and health outcomes are evaluated. With many tables and algorithms to summarise key data and management strategies, Nutritional Strategies for the Very Low Birthweight Infant is an invaluable guide for all healthcare professionals caring for premature babies.
The Department of Child and Adolescent Health has developed guidelines on optimal feeding of low birth weight infants in low- and middle-income countries. These guidelines include recommendations on what to feed low-birth weight infants, when to start feeding, how to feed, how often and how much to feed. The guidelines were developed using the process described in the WHO Handbook for Development of Guidelines. Systematic reviews were conducted to answer 18 priority questions identified by the guidelines development group. The population of interest is low-birth weight infants, and the critical outcomes include mortality, severe morbidity, growth and development. The implementation of these guidelines in low- and middle-income countries is expected to improve care and survival of low birth weight infants.
WHO and UNICEF jointly developed this global strategy to focus world attention on the impact that feeding practices have on the nutritional status, growth and development, health, and thus the very survival of infants and young children. The strategy is the result of a comprehensive two-year participatory process. It is based on the evidence of nutrition's significance in the early months and years of life, and of the crucial role that appropriate feeding practices play in achieving optimal health outcomes. The strategy is intended as a guide for action; it identifies interventions with a proven positive impact; it emphasizes providing mothers and families the support they need to carry out their crucial roles, and it explicitly defines the obligations and responsibilities in this regards of governments, international organizations, and other concerned parties.
Each year in the United States, 250,000 infants are born too soon, weighing too little. For these low birth weight, premature infants, the future is uncertain, since they are at risk for a variety of serious medical and developmental problems—including behavioral and learning disorders that may have damaging effects for the rest of their lives. The extent to which a comprehensive early intervention program could improve or prevent these adverse outcomes was examined in the Infant Health and Development Program, a randomized controlled trial involving almost 1,000 infants in eight cities in the United States. This book describes in detail the program, its research methodology, the progress of the program, and the results of the clinical trial. The program was administered by an interdisciplinary team composed of physicians, biostatisticians, child development specialists, and researchers from several disciplines. It was instituted upon the discharge of the infants from the neonatal nursery and was maintained for three years. One-third of the infants were randomly assigned to an intervention group, the remainder to a follow-up group. Infants in both groups received pediatric care and community referral services, but only those in the intervention group participated in a program that included extensive home visits, attendance at a child development center, and group meetings for parents. The results of the program proved to be clinically important; at age three, the children in the intervention group had significantly higher IQ scores, greater cognitive development, and fewer behavioral problems. The implications of the findings for public policy are equally important, for there is increasing interest in the prevention, early detection, and management of developmental disabilities in children, as evidenced by such legislation as the Education for All Children Act. Strategies to minimize the problems of low birth weight children, with their potential for long-term savings through the prevention of disabilities and their attendant costs, could have significant repercussions in such governmental areas as medical care, education, and social welfare.
Improved conditions of care for premature infants have led to markedly increased survival rates over the last few decades, particularly in very low and extremely low birth weight infants. Nutritional measures play a central role in the long-term outcome, health and quality of life of these premature infants. In this publication, leading experts from all 5 continents present the most recent evidence and critical analyses of nutrient requirements and the practice of nutritional care (with the focus on very low birth weight infants) to provide guidance for clinical application. After the introductory chapters, covering nutritional needs and research evidence in a more general manner, topics such as amino acids and proteins, lipids, microminerals and vitamins, parenteral and enteral nutrition as well as approaches to various disease conditions are addressed. Due to its focus on critical appraisals and recommendations, this book is of interest not only for the researcher who wants to keep up to date, but also for the clinician faced with premature infants in his practice.
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