International Perspectives

Introduction

With continuing advances in preterm baby care, survival rates are increasing in very low-birthweight (VLBW) and very low gestational age newborns in both developed countries and large centers in developing countries. Preterm babies have metabolic characteristics and many diseases and complications due to immaturity that make provision of appropriate nutrition a challenge. Even greater difficulties are encountered with microelements, known also as trace elements or oligoelements, and vitamins because basic needs are not always perfectly defined. There are also no evident clinical signs of deficiency during the neonatal period, so the neonatologist is not always aware of a need to supplement them.

Several situations contribute to deficiencies in these nutrients among VLBW preterm babies: human milk fortifiers do not contain all the necessary micronutrients or contain them in insufficient quantities; formula milks have different ingredients in different countries, with the most suitable ones often not available; and formulas for parenteral nutrition do not provide the necessary micronutrients, such as selenium. Recently, supplementation of minerals such as selenium and vitamins A and E, which have antioxidant properties, has been evaluated clinically for the possible prevention of preterm infant diseases in which free radicals have pathophysiologic importance. Also, many studies have been undertaken on mineral and vitamin supplements for pregnant mothers in poorer countries that are aimed at reducing low birthweight and perinatal and infant mortality.

Microelements

The important microelements in human nutrition are zinc, copper, selenium, chromium, molybdenum, manganese, iodine, and iron. Although they only represent a small fraction of the human body’s total mineral content, they play important roles in various metabolic routes. Preterm babies can present with deficiencies, even without clinical signs, due to low concentrations of the elements at birth because these minerals are only incorporated in the last trimester of pregnancy.

Selenium

The importance of selenium increases in all …