TableĀ 4

Strategies to consider when addressing poor nutrient intakes and growth in neonates

For infants receiving parenteral nutrition (PN)Concentrate concurrent infusions to allow greater volume of PN to be given
Concentrate PN to provide same nutrition in a smaller volume (if other infusions are preventing target infusion volume from being given)
Increase amount of specific nutrients in PN to address specific deficits identified
Start some enteral feeds in addition to PN to provide extra nutrition
For infants receiving enteral feedsIncrease feed volume if clinical condition allows
For infants on breast milk, consider adding breast milk fortifier. For infants on formula milk, consider changing to preterm formula if not already on this, or consider higher nutrient density formulas
Address specific nutrient deficits using supplements (e.g. sodium or phosphate supplements)
Ensure infants are receiving appropriate iron and vitamin supplements when fully fed
For infants on both PN and enteral feedsConsider increasing total fluid volume, in order to allow maximum PN and feed volume and therefore maximise nutrient intake
All infantsConsider addressing disease states which may influence nutritional needs (e.g. provide increased respiratory support where appropriate to infants with chronic lung disease in order to reduce energy needs and enable a period of growth)