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Neo Reviews

NeoReviews current issue


  • Enteral Feeding of the Preterm Infant
    Premature infants commonly suffer from extrauterine growth restriction from inadequate nutrition and the loss of the last months of gestation, a critical period for brain and body growth. Providing optimized nutrition for the premature infant is a crucial task of the neonatologist and has a significant impact on the future growth and neurodevelopment of these infants. Enteral feeding is nuanced in the preterm population and requires specific knowledge of the nutritional requirements of the preterm infant and the various substrates and methods available to achieve proper nutrition.


  • Probiotics, Prebiotics, and Synbiotics for Preterm Neonates
    Probiotics have been extensively studied in neonates over the past several decades. Multiple meta-analyses have found probiotics to be effective at decreasing the number of necrotizing enterocolitis incidents. While relatively few NICUs in the United States are routinely using probiotics, many NICUs around the world have been doing so for more than a decade. The barriers to the routine use of probiotics include safety concerns and the lack of a clear consensus on the preferred formulation, dosage, and duration. Further research must be done to determine the safest and most effective formulation. This article discusses the history of probiotics, mechanisms of protection, available clinical evidence, and barriers to the use of probiotics in neonates. This review also addresses the current state of evidence regarding the naturally occurring substances called prebiotics, which can be added to formulas in the form of a supplement to promote intestinal colonization with commensal organisms, and synbiotics, which are combination products containing both probiotic cultures and prebiotic substrates.


  • Influences of Feeding on Necrotizing Enterocolitis
    Necrotizing enterocolitis (NEC) remains one of the leading complications of prematurity with an incidence of 5% to 13% and a mortality of up to 30%. Its occurrence is inversely related to gestational age, with the most premature neonates being at highest risk. Despite numerous studies assessing risk factors, the most commonly observed associations remain prematurity and enteral feeding. Furthermore, studies have pointed to receipt of breast milk as a protective factor in decreasing the risk of NEC and formula feeding as potentially increasing the risk. Other potential risk factors and associations in the premature infant include lack of antenatal steroids, receipt of prolonged courses of postnatal antibiotics, presence of anemia, receipt of packed red blood cell transfusions, and presence of a patent ductus arteriosus. Despite the recognition that NEC remains a serious complication of prematurity, there is still no specific prescription for its prevention. Given that enteral feeding is one of the most commonly observed risk factors for the development of NEC, wide variation exists in the enteral feeding recommendations and practices for premature infants. Feeding practices that may contribute to NEC, which remain variable in practice, include feeding strategies used in the presence of a hemodynamically significant patent ductus arteriosus and feeding during packed red blood cell transfusions. Use of breast milk (mother’s own milk or donor milk) is recognized as one of the mainstays of NEC prevention. This article explores multiple influences of feeding on the development of NEC.


  • The Rapidity of Advancement of Feedings in Premature Infants: Evidence Basis and Current Recommendations
    It is every neonatologist’s aspiration to achieve “optimal postnatal growth” in preterm infants, because nutrition and growth of this population affect long-term neurodevelopmental outcomes. However, despite having this common goal, there are huge variations in the enteral feeding practices of preterm infants across the globe. One such practice is the rate of advancement of enteral feedings; there is no consensus about the optimal approach, even among international nutritional experts. In this review, we aim to provide readers with the rationale for different practices in feeding advancement and summarize the current literature.