David Adamkin

• MD
• University of Louisville

Neonatal Care: A Compendium of AAP Clinical Practice Guidelines and Policies, 2nd Edition, provides the most recent and trustworthy content and recommendations from the American Academy of Pediatrics (AAP) Committee on Fetus and Newborn and other relevant AAP committees, sections, and councils. This compendium contains the collected AAP clinical pr...

Human milk is the gold standard to provide nutritional support for all healthy and sick newborn infants including the very low birth weight (VLBW) infant (<1500 g). It has both nutritional and anti-infective properties which are especially important for these infants at risk for sepsis and necrotizing enterocolitis. Human milk alone is insufficient...

Respiratory distress syndrome (RDS) remains a leading cause of neonatal morbidity despite new strategies with surfactant and both invasive and noninvasive mechanical ventilation. Nutrition also plays a key role in the support of these infants and in the prevention and management of bronchopulmonary dysplasia (BPD).

Glucose supply and metabolism are essential for growth and normal brain development in both the fetus and newborn. Disorders of glucose availability and metabolism can result in either hypoglycemia or hyperglycemia. The first section of this manuscript will contrast recommendations from the American Academy of Pediatrics and the Pediatric Endocrine...

Preterm infants are increasingly diagnosed as having “extrauterine growth restriction” (EUGR) or “postnatal growth failure” (PGF). Usually EUGR/PGF is diagnosed when weight is <10th percentile at either discharge or 36–40 weeks postmenstrual age. The reasons why the phrases EUGR/PGF are unhelpful include, they: (i) are not predictive of adverse out...

This new compendium gives you a single place to look for the most recent and trustworthy recommendations on quality care of pregnant women and their newborn infants. https://shop.aap.org/neonatal-care-a-compendium-of-aap-clinical-practice-guidelines-and-policies-paperback/

The management of low blood glucose concentrations in the first 48 h of life is one of the most frequently encountered issues the clinician faces in the newborn nursery. The blood levels of glucose upon which we base our decision-making remain more a matter of expert opinion rather than being evidence-based, and a consensus on blood glucose levels...

Objective: To compare growth, feeding tolerance, and clinical and biochemical evaluations in human milk-fed preterm infants randomized to receive either an acidified or a nonacidified liquid human milk fortifier. Study design: This prospective, controlled, parallel, multicenter growth and tolerance study included 164 preterm infants (≤32 weeks o...

Objective: The study objective was to explore the relationship between necrotizing enterocolitis (NEC) and packed red blood cell (pRBC) transfusion in very low birth weight (VLBW) neonates (<1500 g). Study design: A six-year retrospective chart review of VLBW infants with NEC (Bell's Stage > II) and a pRBC transfusion within 48 hours of diagnosi...

Objective: To determine the maximum dilution of human milk (HM) that yields reliable results for protein, fat and lactose when analyzed by mid-infrared spectroscopy. Study design: De-identified samples of frozen HM were obtained. Milk was thawed and warmed (40°C) prior to analysis. Undiluted (native) HM was analyzed by mid-infrared spectroscopy...

Objective: To track individual mother's macronutrient variability in preterm human milk (HM) over 6 weeks of lactation. Study design: This was a prospective, observational study of mother's own milk from women who delivered a very low birth weight infant (<1500 g). A single, random maternal breast milk sample was collected and analyzed weekly fo...

A consistent definition for neonatal hypoglycemia in the first 48 h of life continues to elude us. Enhanced understanding of metabolic disturbances and genetic disorders that underlie alterations in postnatal glucose homeostasis has added useful information to understanding transitional hypoglycemia. This growth in knowledge still has not led to wh...

Human milk is the preferred feeding for all infants, including those of very low birth weight (<1500 g). It has both nutritional and anti-infective properties which are especially important for infants at risk for sepsis and necrotizing enterocolitis. When maternal milk is not available or the amount produced is not sufficient to meet daily needs,...

Objective: To evaluate the safety and explore the efficacy of recombinant human lactoferrin (talactoferrin [TLf]) to reduce infection. Study design: We conducted a randomized, double blind, placebo-controlled trial in infants with birth weight of 750-1500 g. Infants received enteral TLf (n = 60) or placebo (n = 60) on days 1 through 28 of life;...

Purpose of review: The screening and management for neonatal hypoglycemia remains a confusing and contentious problem in neonatology. The purpose of this article is to contrast recent recommendations from the American Academy of Pediatrics and the Pediatric Endocrine Society. Recent findings: Using different methodologies, the organizations have...

JPER is a multi-disciplinary journal that promotes the health of the preterm infant.

Objective: Lactoferrin (Lf), the dominant protein in human milk (HM), has been shown to have anti-inflammatory and anti-microbial activity in the neonatal gut. Previous studies indicate that freezing significantly decreases the concentration of Lf in HM. The objective of our study was to compare the activity of Lf in fresh and frozen HM over time....

Objective: The objective of this study is to determine whether the use of donor human milk (DHM) in very low birth weight (VLBW, ⩽1500 g) neonates in a large neonatal intensive care unit (NICU) affected the rate of necrotizing enterocolitis (NEC) or impacted growth. Study design: This was a retrospective chart review of 550 VLBW neonates followi...

JPER is a multi-disciplinary journal that promotes the health of the preterm infant.

Although individual metabolic diseases are relatively uncommon, inherited metabolic diseases collectively represent a more common cause of disease in the neonatal period than is generally appreciated. Newborn screening is among the most successful public health programs today. Every day, newborns considered to be at risk for hypoglycemia are screen...

Human milk is the best food for human infants, including those born preterm. Human milk feeding benefits the preterm infant by improving mental and motor development, decreasing the risk of necrotizing enterocolitis, sepsis, and retinopathy of prematurity during the postnatal period spent in the Neonatal Intensive Care Unit. In order to support the...

A number of adaptations in total parenteral nutrition (TPN) protocols and practices for preterm neonates have been realized in the past several years, resulting in better survival and developmental outcomes. The early provision of appropriate concentrations of amino acids and energy are now recommended in evidence-based guidelines. Standardized TPN...

Objective. To evaluate the contribution of real-time human milk (HM) analysis in the development of individual fortification plans for very low birth weight (VLBW) infants (<1500 g). Methods. Pooled, 24-hour samples of HM were analyzed 1 to 2 times weekly. HM was fortified using 30 kcal/oz preterm formula (PTF) or acidified concentrated liquid form...

The American Academy of Pediatrics supports the feeding of human milk for all infants. Very-low-birth-weight and extremely low-birth-weight infants especially can benefit from the immune and neurodevelopmental effects of human milk. However, human milk alone is nutritionally inadequate for the rapid growth of the very-low-birth-weight infant during...

New! Keep up with current practice guidelines and policies with the latest, most up-to-date edition of this clinical reference classic. This evidence-based decision-making tool for managing common pediatric conditions has been revised and updated for 2014, with the latest clinical practice guidelines for more than 30 conditions, plus every AAP poli...

Objective: Lactoferrin from human milk (HM) provides antimicrobial and anti-inflammatory action in the neonatal intestine. HM-fed, critically ill neonates often receive previously frozen milk. Freezing is known to have deleterious effects on proteins. The aim of this study was to determine the effect of low temperature storage of HM on the concent...

Keep up with current practice guidelines and policies with the latest, most up-to-date edition of this clinical reference classic. This evidence-based decision-making tool for managing common pediatric conditions has been revised and updated for 2013, with the latest clinical practice guidelines for more than 30 conditions, plus every AAP policy st...

To use real-time human milk macronutrient analysis to calculate final composition following fortification. Preterm HM (PHM) and pooled donor human milks (DHM) were analyzed by mid-infrared spectroscopy for protein, fat and lactose. Energy content was calculated from macronutrient results. Three lactation stages were constructed. DHM was compared to...

Background and objective: Human milk (HM) is the preferred feeding for human infants but may be inadequate to support the rapid growth of the very-low-birth-weight infant. The creamatocrit (CMCT) has been widely used to guide health care professionals as they analyze HM fortification; however, the CMCT method is based on an equation using assumpti...

Human milk is the ideal nutrient for neonates. Breastfeeding exposes neonates to maternal microflora, provides host protection, and has proteins that mediate immune systemdevelopment. Lactoferrin (LF) is the major whey protein in mammalian milk, and its multifunctional characteristics have shown importance in preventing infections. Ferric iron bind...

Objective: To analyze amino acid profiles and serial blood urea nitrogen values (BUN) in infants <1250 g receiving early amino acid infusion within hours of birth and compare them to previously published values. Design/methods: A retrospective study was conducted on infants <1250 g admitted to the NICU between July 2009 to July 2010. Plasma amino a...

Dietary carotenoids (lutein, lycopene and β-carotene) may be important in preventing or ameliorating prematurity complications. Little is known about carotenoid status or effects of supplementation. This randomized controlled multicenter trial compared plasma carotenoid levels among preterm infants (n=203, <33 weeks gestational age) fed diets with...

Once critically ill, preterm infants have transitioned to enteral or oral feedings, it is common to mix oral medications with milk feedings. The osmolality of oral and intravenous drugs were tested in the 1980s and many were found to exceed the American Academy of Pediatrics (AAP) recommended limit (400 mOsm kg(-1) H(2)O). Many new milks and medica...

Changes in nutritional strategies over the past decade have been shown to improve postnatal growth in extremely low birth weight (ELBW) infants. We showed 10 years ago that the majority of these ELBW infants with bronchopulmonary dysplasia (BPD) suffer postnatal growth failure. We theorized that recent changes in nutritional support strategies woul...

Dietary carotenoids possess antioxidant, anti‐inflammatory, and light‐absorbing characteristics. Lutein is also the major component in infant retinal pigment. Preterm infants represent a population in which increased inflammation and oxidative stress are associated with common diseases of prematurity. Infants (n=203) < 33 wks GA were randomized to...

JPER is a multi-disciplinary journal that promotes the health of the preterm infant.

This report provides a practical guide and algorithm for the screening and subsequent management of neonatal hypoglycemia. Current evidence does not support a specific concentration of glucose that can discriminate normal from abnormal or can potentially result in acute or chronic irreversible neurologic damage. Early identification of the at-risk...

The hospital stay of the mother and her healthy term newborn infant should be long enough to allow identification of early problems and to ensure that the family is able and prepared to care for the infant at home. The length of stay should also accommodate the unique characteristics of each mother-infant dyad, including the health of the mother, t...

It is our opinion that proceeding with additional regulations without appropriate evaluation of current outcomes and without advanced planning to determine optimal infrastructure, resources, methods, personnel, and scheduling required to optimize the training of new specialists and subspecialists gravely risks the delivery of patient care and the f...

To evaluate early amino-acid (AA) administration in extremely low birth weight (ELBW) infants over three time periods, beginning with the initiation of this strategy. This was a retrospective study of ELBW infants between 2000 and 2007. Nutritional intake and laboratory results were monitored during the first 5 days of life. Growth rates and compli...

The identification of late preterm infants as a high-risk group of infants has been an important public health breakthrough. These infants have suffered a relative 'silent morbidity and mortality' before the recognition that they have unique physiology and risks. These infants represent almost three-fourths of all premature births in the United Sta...

The goal of nutritional management in VLBW and ELBW infants is the achievement of postnatal growth at a rate that approximates the intrauterine growth of a normal fetus at the same postconceptional age. In reality, however, growth lags considerably after birth; although non-nutritional factors are involved, nutrient deficiencies are critical in exp...

This Policy Statement was reafirmed May 2011 and November 2018 This policy statement updates the guidelines on discharge of the high-risk neonate first published by the American Academy of Pediatrics in 1998. As with the earlier document, this statement is based, insofar as possible, on published, scientifically derived information. This updated st...

The study objectives were to confirm the incidence of cholestasis and determine factors that contribute to its development and the natural course of cholestasis in neonates treated with extracorporeal membrane oxygenation (ECMO). This was a retrospective chart review including all patients receiving ECMO between 1995 and 2005 at Kosair Children's H...

Lipids are essential components of parenteral nutrition for preterm infants to provide essential fatty acids and to meet high energy needs. However, there is concern about increased risks of sepsis, displacement of bilirubin from albumin, and pulmonary complications when parenteral lipids are provided to sick preterm infants early in postnatal life...

Postnatal growth failure in the extremely low birthweight infant is a morbidity that needs vigorous attention. The transition from intrauterine to the extrauterine environment should occur with minimal disruption in nutritional support. Early aggressive parenteral and enteral nutrition strategies may lead to reducing cumulative deficits of energy a...

The breast-fed infant is the gold standard for infant formula research and development. The addition of long-chain polyunsaturated fatty acids and nucleotides to formula are intended to promote visual, neuro and immune development. Studies in both preterm and term infants have not consistently demonstrated efficacy with long-chain polyunsaturated f...

Important differences in clinical outcomes become apparent when hospital courses of late preterm infants are compared with those of full-term infants. Differences in feeding issues and strategies mirror those differences in outcomes. Late preterm infants may masquerade as term infants on the basis of their relatively large size and mature, chubby a...

Nutrient-enriched diets for preterm infants after hospital discharge (preterm formula or postdischarge formula (PDF)) results in improved growth and these differences appear to persist beyond the period of nutrient intervention. The PDF diet effect is greatest in males, possibly reflecting their higher growth rates. The critical growth epoch appear...

The Apgar score provides a convenient shorthand for reporting the status of the newborn infant and the response to resuscitation. The Apgar score has been used inappropriately to predict specific neurologic outcome in the term infant. There are no consistent data on the significance of the Apgar score in preterm infants. The Apgar score has limitat...

Purpose To compare metabolic and physiologic responses of extremely low birth weight (ELBW: # 1,000 g) neonates to early (# 24 hours.) or later (> 24 hr) initiation of intravenous amino acids (iAA) with glucose in the first 6 days of life. Methods This study received IRB approval prior to initiation. Infants were born between 1/1/2000 and 12/31/01...

Extremely low birth weight infants may experience periods of moderate to severe undernutrition during the acute phase of their respiratory problems. This undernutrition contributes to early growth deficits in these patients and may have long-lasting effects, including poor neurodevelopmental outcome. Early postnatal intravenous amino-acid administr...

The goal of nutritional management of very-low-birth weight (VLBW), <1500 g, infants that has been supported by the American Academy of Pediatrics Committee on Nutrition (1-3) is the achievement of postnatal growth at a rate that approximates the intrauterine growth of a normal fetus at the same postconceptional age. Yet in reality the growth of th...

In a recent meta-analysis, human milk feeding of low birth-weight (LBW) infants was associated with a 5.2 point improvement in IQ tests. However, in the studies in this meta-analysis, feeding regimens were used (unfortified human milk, term formula) that no longer represent recommended practice. To compare the growth, in-hospital feeding tolerance,...

Immaturity of the gastrointestinal tract in very-low-birth-weight infants (<1500 g) (VLBW) precludes substantive nutritional support from enteral nutrition. Therefore, nearly all these infants are supported with parenteral nutrition (PN). In addition, PN has revolutionized the outcome for neonates and infants with intestinal failure either from con...

To assess nutritional intakes and subsequent growth of extremely low birth-weight (BW) infants. Chart review of 69 extremely low BW infants stratified into two groups by BW: < or =750 g (group 1; n=27) or 751 to 1000 g (group 2; n=42). Dietary intakes, weights, and head circumferences (HC) were collected through discharge and at 1 month postdischar...

Long-term growth failure in very very low birth weight (VVLBW) infants is a common complication of extreme prematurity. Critical illnesses create challenges to adequate nutriture. To identify predictors of extrauterine growth retardation (EUGR) in VVLBW infants and to evaluate their nutritional intake and subsequent growth. A 4-year retrospective c...

To determine if docosahexaenoic acid (DHA) and arachidonic acid (ARA) supplementation influences growth or visual acuity of formula-fed premature infants. Double-blind, multi-center study of 194 premature infants given preterm formula with no DHA or ARA (control), 0.15% energy DHA, or 0.14% DHA + 0.27% ARA from single-cell triglycerides for at leas...

Two relatively new strategies in the nutritional management of the extremely low birthweight infant include early administration of amino acids and the integration with minimal enteral nutrition within the first days of life. These strategies will promote early positive energy balance and nitrogen retention as well as stimulate the functional integ...

This study was conducted to determine if early postnatal discharge (EDC; < or =48 hours) in well newborns had an effect on the rate of hospital readmission within the first week after hospital discharge when compared to infants who remained >48 hours after birth (later discharge, LDC). This was a retrospective medical chart review. Charts of infant...

A randomized, masked, controlled trial was conducted to assess effects of supplementing premature infant formulas with oils containing the long-chain polyunsaturated fatty acids, arachidonic acid (AA; 20:4 n6), and docosahexaenoic acid (DHA; 22:6 n3) on growth, visual acuity, and multiple indices of development. Infants (N = 470) with birth weights...

This study was conducted to determine if early postnatal discharge (< or = 48 hrs; EDC) in well newborns had an effect on the rate of hospital readmission within the first week after hospital discharge when compared to infants who remained > 48 hrs after birth (LDC). This was a retrospective medical chart review. Infants who were born at Norton Hos...

A prospective, double-blind, randomized, controlled trial was conducted to evaluate the growth and nutritional status of preterm infants receiving preterm human milk supplemented with a newly formulated powdered human milk fortifier (HMF), study fortifier (SF), or a powdered commercial HMF (CF). Infants (n = 144) with a birth weight </=1600 g and g...

The last trimester of pregnancy is a period of rapid accretion of long-chain polyunsaturated fatty acids, both in the central nervous system and the body as a whole. Human milk contains these fatty acids, whereas some preterm infant formulas do not. Infants fed formulas without these fatty acids have lower plasma and erythrocyte concentrations than...

Given the many benefits of feeding human milk to both term and preterm infants, policies have been implemented in NICUs to support the provision of human milk to infants. Purpose: To determine the impact of type of feeding on the growth, in-hospital feeding tolerance, and morbidity of premature infants. Design: Infants (n=463) with birthwts of 750...