Malnutrition in very low birth-weight, pre-term infants.

When a very low birth-weight, pre-term infant is compared with a foetus o i equivalent gestational age in utero it becomes apparent that he is suffering from malnutrition, and is at times close to death from starvation. There is evidence for this from a variety of sources and it is my purpose to present some of this evidence and to consider the problems we have encountered with pre-term babies while trying to improve their nutrition. When, at birth, the umbilical cord is cut, very low birth-weight, pre-term infants face a period of complete starvation. This period is generally very short but if there is any impediment to oral feeding-and there frequently is-then they may have to rely on an intravenous dextrose drip for a number of days. Table I gives the survival time in days for premature and full-term infants compared with an adult (Heird, Driscoll, Schullinger, Grebin & Winters, 1972). These values are based on the Table I. Calculated suraival times (d)" for premature and fiill-term infants, and adults, with intakes of water only or dextrose solution estimated energy reserves of these infants and their rate of energy expenditure, and illustrate the urgent need to introduce adequate nutrition as soon after birth as possible. Bhangananda & Mehta, 1966) performed during the first 48 h of life have demonstrated negative nitrogen balance which, though minimized by a dextrose infusion (IOO g/l), may nevertheless be equivalent to a loss of 3*5y0 of body protein in the first 48 h of life. Such a situation may be innocuous for a full-term infant provided with adequate body stores, but may be very damaging for a low birth-weight infant, who should be embarking on a rapid phase of exponential growth at a time when his body stores are trivial. In experimental animals, malnutrition at such a time permanently reduces the brain in size and cell number and this effect cannot be reversed by a period of liberal feeding later on (Elliott & Knight, 1972). Such drastic