Oral Nutritional Challenges in Neonatal Intensive Care Unite

Preterm neonates face significant nutritional challenges due to their immaturity, leading to a high risk of nutrient deficiencies and growth failure. This is primarily because they miss the crucial third trimester for nutrient accumulation in utero. Specific issues include difficulties with sucking and swallowing, potential gastrointestinal issues, and the need for specialized fortified feedings. The goal of nutrition of the preterm infant is to provide nutrients to meet the growth rate and body composition of the normal healthy fetus of the same gestational age in terms of weight, length, and head circumference, organ size, tissue components including cell number and structure, concentrations of blood and tissue nutrients, and developmental outcomes. Failure to provide the necessary amounts of all of the essential nutrients to preterm infants has produced not only growth failure, but also increased morbidity and less than optimal brain growth that would limit neurodevelopment. Several practical aspects of medical management to better optimize the benefits of enhanced and improved nutrition in very preterm infants right after birth should be noted. Improved medical care and physiological condition, Oxygenation, IV (Parenteral) Feeding, IV dextrose (glucose) infusion, IV lipid infusion, IV amino acid infusion, IV insulin infusion. The postnatal growth window is crucial to ensure adequate outcomes for extremely preterm infants. As this review has emphasized, right from parenteral nutrition, it is necessary to consider the characteristics of the single infant and provide adequate nutrients (glucose, lipids, and proteins) and micronutrients (electrolytes, vitamins, and minerals) both quantity and quality-wise. Early start of enteral feeding within ۲۴ h of life is safe, if there are no warning signs or symptoms and can allow to reach earlier full enteral feeding, advancing meals by up to ۲۰-۳۰ mL/kg every day (where clinically acceptable). This is related to a lower duration of the parenteral nutrition, and an earlier removal of central venous catheter, with the reduction of related complications. With the establishment of full enteral nutrition, hopefully with human milk, adequate fortification of human milk is necessary: adjustable or targeted fortification strategies increase growth velocity compared to standard fortification. The monitoring of the trend of growth parameters (weight, length, and head circumference), assessed once a week during hospitalization, can allow for a decrease in extra-uterine growth restriction by tailoring the newborn's nutrition and leading to better outcomes. Finally, it is important not to forget the importance of adequate growth even after discharge, as poor growth is