What are the considerations for a 25-day-old premature infant with Intrauterine Growth Restriction (IUGR)?

From the Guidelines

For a 25-day-old premature infant with Intrauterine Growth Restriction (IUGR), close monitoring and specialized nutritional support are essential to reduce morbidity, mortality, and improve quality of life. The infant requires higher caloric intake of 110-130 kcal/kg/day with protein intake of 3.5-4.5 g/kg/day to support catch-up growth, as recommended by recent guidelines 1.

Key Considerations

• Breast milk is preferred, fortified with human milk fortifier to increase caloric density to 24-30 kcal/oz.
• If formula is needed, a premature formula (such as Similac Special Care or Enfamil Premature) should be used.
• Feeding should be frequent, every 2-3 hours, with careful monitoring for feeding intolerance.
• Growth parameters including weight, length, and head circumference should be tracked daily or at minimum three times weekly, plotting on appropriate preterm growth charts.

Potential Complications

• These infants are at risk for complications including hypoglycemia, hypothermia, and necrotizing enterocolitis, so blood glucose monitoring, maintaining optimal environmental temperature, and watching for abdominal distension or bloody stools is crucial.
• Supplementation with iron (2-4 mg/kg/day), vitamin D (400-800 IU/day), and multivitamins is typically needed, as supported by recent studies 1.

Management

• Regular follow-up with a neonatologist and pediatric nutritionist is important to adjust the feeding plan as the infant grows.
• The goal is to achieve growth rates similar to intrauterine growth in the third trimester, approximately 15-20 g/kg/day.
• Management of FGR is based on early diagnosis, optimal fetal surveillance, and timely delivery that reduces perinatal mortality and minimizes short- and long-term morbidity, as outlined in recent guidelines 1.

From the FDA Drug Label

Caffeine citrate should be administered with caution in preterm neonates with impaired renal or hepatic function. Serum concentrations of caffeine should be monitored and dose administration of caffeine citrate should be adjusted to avoid toxicity in this population. In neonates, the T1/2 is approximately 3-4 days and the Ae is approximately 86% (within 6 days). The safety and efficacy of caffeine citrate for use in infants with Intrauterine Growth Restriction (IUGR) have not been established.

For a 25-day-old premature infant with Intrauterine Growth Restriction (IUGR), the following considerations should be taken into account:

• Caffeine citrate should be administered with caution due to the potential for impaired renal or hepatic function in preterm neonates.
• Serum concentrations of caffeine should be monitored to avoid toxicity.
• The safety and efficacy of caffeine citrate for use in infants with IUGR have not been established.
• Dose administration of caffeine citrate should be adjusted based on the individual patient's needs and renal or hepatic function.
• Key considerations include:
  • Impaired renal or hepatic function
  • Monitoring of serum concentrations
  • Adjustment of dose administration
  • Lack of established safety and efficacy in IUGR 2 2

From the Research

Considerations for a 25-day-old Premature Infant with Intrauterine Growth Restriction (IUGR)

• The infant is at a higher risk of experiencing acute problems in the perinatal and early neonatal period, which can be life-threatening 3, 4.
• Careful monitoring is necessary to balance achieving optimal catch-up growth and preventing the onset of cardiovascular and metabolic disorders in the long-term 3.
• The infant may have many acute neonatal problems, including perinatal asphyxia, hypothermia, hypoglycemia, and polycythemia 4.
• Long-term complications that may develop include growth retardation, major and subtle neurodevelopmental handicaps, and developmental origin of health and disease 4, 5.
• The infant is at a higher risk of morbidity and mortality, with increased risk of necrotizing enterocolitis, need for respiratory support, and retinopathy of the premature 6.
• Interdisciplinary and interprofessional care, including risk-adapted care at level III centers, psychosocial interventions, and neonatal consultations, may be beneficial 5.
• Postnatally, integrated neonatal care focusing on parent-child interaction and optimized nutrition is important, along with in-depth pediatric follow-up visits to identify growth and neurodevelopment problems early 5.