Q1) What are the problems in feeding of LBW babies?
A1) The preterm / LBW infant faces several nutritional problems due to :-

• Immature organ systems
• Poor suck swallow coordination till 34 weeks of gestation
• Weak suck reflex in VLBW babies
• Small gastric capacity
• Incompetent gastroesophageal sphincter, poor gag reflex
• Decreased activity of enzymes - lactases & lipases. Also decreased activity of other enzymes responsible for catabolism of tyrosine and methionine to cystine
• Decreased bile acid pool
• Low glomerular filtration rate & decreased concentrating capacity of kidney
• Smaller metabolic reserves: Decreased stores of glycogen/ fat/ vitamins/ minerals
• Greatly increased energy requirements - due to high basal metabolic rate, increased growth, increased stress & associated metabolic problems like hypoglycemia

Q2) What are the nutritional goals?
A2) The aim of feeding should be to approximate intrauterine growth, a goal that is frequently impossible to attain. The quality of weight gained and composition of tissue accrued though difficult to measure, (protein accretion rather than fat accretion & water retention) is a better determinant of adequacy of nutrition.