Enteral feeding and infections in preterm neonates

Infections are major morbidities in preterm neonates. They represent the main cause of death of these particular patients. Malnutrition increases the risk of infections. Immaturity of neonatal gut system limits the use of enteral nutrition in the early life of preterm neonates. Additionally, the risk of necrotizing enteroco- litis frequently allows to enteral nutrition avoidance or suspension. Starvation produces modification in mucosal barrier integrity (favoring bacterial translocation), immune response, and microflora composition. Deficit of specific nutrients (i.e., amino acids, lipids, vitamins, microelements) reduces defenses against infections and increases the risk of inflammatory damage. On the other hand, adequate nutritional support may prevent occurrence of many infectious disease, by improvement of immune response, epithelial barrier integrity, and microflora composition. The use of minimal enteral feeding (10–20 ml/kg of body weight), during a period of feeding intolerance, could be considered an efficacious nutritional strategy against infections in neonates.