What are the recommended feeding strategies for infants with Intrauterine Growth Restriction (IUGR) experiencing feeding difficulties?

Feeding Strategies for IUGR Infants with Feeding Difficulties

For infants with Intrauterine Growth Restriction (IUGR) experiencing feeding difficulties, a multidisciplinary feeding approach involving specialized feeding evaluation and therapy is strongly recommended to ensure optimal growth and development.

Understanding IUGR and Feeding Challenges

IUGR infants often experience feeding difficulties due to:

• Impaired gut function resulting from placental dysfunction and the "brain sparing effect" 1
• Weak suck, easy fatigability, and low muscle tone 2
• Higher risk of necrotizing enterocolitis (NEC) in preterm IUGR infants 1
• Disordered suck and swallow reflexes and textural aversion 2

Initial Feeding Assessment and Management

Breastfeeding Support

• Breastfeeding is highly recommended when feasible 3
• For exclusively breastfed infants:
  • Consider using nursing systems with one-way valves and manual assistance of sucking (e.g., Haberman nipple, Pigeon feeder) 2
  • Monitor weight gain closely with frequent weight checks 2

Formula Feeding Considerations

• If formula is needed, ensure adequate protein-to-energy ratio, minerals, and trace elements 3
• Increased caloric density of feedings is often helpful for IUGR infants 2

Specialized Feeding Interventions

For Mild to Moderate Feeding Difficulties

• Feeding evaluation by specialists to assess aspiration risk and dysphagia 2
• Feeding therapy to help with transition to solid foods 2
• Regular monitoring of growth parameters using appropriate growth charts 3

For Severe Feeding Difficulties

• Gavage feeding (nasogastric tube) may be considered temporarily 2

  • Should be limited to cases where feeding is the last issue requiring continued hospitalization
  • Not all parents can safely manage home gavage feedings
  • Generally well-tolerated and rarely required for more than 3-6 months

• Gastrostomy tube placement should be considered only when:

  • Little or no progress is made with oral feeding skills
  • Long-term tube feeding seems inevitable 2
  • Continue oral feeding alongside tube feeding to develop oral feeding skills 2

Nutritional Monitoring and Supplementation

• Monitor weight, length, and head circumference regularly to identify growth faltering 3
• After reaching term-equivalent age, include weight-for-length z-scores to assess proportionate growth 3
• Provide supplements for infants needing to catch up on growth:
  • Vitamin D and iron supplementation through at least 12 months corrected age 3
  • Regular ferritin monitoring for iron status 3

Special Considerations for Preterm IUGR Infants

• Early enteral feeding has been shown to be safe, contrary to previous practices of delaying feeds 1
• Breast milk appears to offer protection against NEC in this population 1
• Consider intensive multidisciplinary feeding intervention (IMFI) involving psychology, medicine, nutrition, and feeding specialists 4

Follow-up Care

• Infants discharged with significant drops in weight and length (exceeding -2 standard deviation) require tailored nutritional support 3
• Refer to specialized centers for pediatric nutritional care or ensure the general pediatrician receives appropriate training 3
• Introduction of solid foods should coincide with neurological developmental milestones rather than adhering to a set age 3

Common Pitfalls to Avoid

• Delaying feeds unnecessarily in IUGR infants due to fear of NEC (recent evidence supports early feeding) 1
• Overlooking the long-term health implications of IUGR (metabolic syndrome, cardiovascular disease) when focusing only on short-term weight gain 5
• Discontinuing feeding support too early before establishing consistent feeding patterns
• Failing to balance optimal catch-up growth with preventing cardiovascular and metabolic disorders long-term 5

By implementing these specialized feeding strategies and ensuring close monitoring, IUGR infants with feeding difficulties can achieve improved nutritional outcomes and better long-term health.