“Gainer and Grower” Programs for Premature Infants: A Nursing Guide
Definition
“Gainer and Grower” is a concept often applied in the care of premature infants focused on optimizing growth and nutrition to support healthy weight gain and development. Since preterm infants are at risk for growth delays and nutritional deficiencies due to early birth, this approach emphasizes providing tailored nutritional support and monitoring for optimal physical and cognitive development.
Importance of Growth in Premature Infants
Growth is a critical indicator of health and development in premature infants. The goal is to help them achieve “catch-up growth” to meet developmental milestones closer to their full-term peers. Insufficient growth can lead to complications such as delayed neurodevelopment, immune issues, and long-term health challenges.
Nutritional Needs
1. Parenteral Nutrition (PN): In the early stages after birth, especially for very low birth weight (VLBW) infants, intravenous nutrition may be necessary to meet caloric and nutritional needs. PN typically includes essential nutrients like proteins, lipids, and carbohydrates.
2. Enteral Nutrition (EN): As the infant stabilizes, enteral feeding (often through a nasogastric or orogastric tube) begins with breast milk or specialized preterm formulas. Breast milk is preferred for its immune benefits, although it may be fortified to ensure adequate caloric and nutrient intake.
3. Fortification and Supplementation: Premature infants often require additional vitamins and minerals (e.g., calcium, phosphorus, and iron) to support bone development and red blood cell production.
Nursing Care and Interventions
1. Regular Weight and Growth Monitoring: Track daily weight, length, and head circumference to monitor growth. The nurse records these metrics and plots them on growth charts specific for preterm infants.
2. Feeding Support and Advancement: Collaborate with dietitians to determine optimal feeding plans, adjusting volume and frequency based on tolerance and growth progress. Monitor for feeding intolerance (e.g., abdominal distension or vomiting).
3. Fluid and Electrolyte Balance: Ensure the appropriate fluid balance by monitoring intake and output, as premature infants are prone to dehydration or fluid overload.
4. Skin-to-Skin Care (Kangaroo Care): Encourage skin-to-skin contact with parents, which has been shown to improve weight gain, stabilize vital signs, and support neurodevelopment.
5. Parent Education and Support: Educate parents on the importance of nutrition for growth, feeding techniques, and signs of feeding intolerance. Emotional support is essential, as parents may feel anxious about their infant’s growth and development.
Outcomes and Challenges
• Premature infants in “gainer and grower” programs generally show improvements in growth and development.
• Challenges include feeding intolerance, the risk of necrotizing enterocolitis (NEC), and the need for ongoing adjustments to nutrition as the infant grows.
Conclusion
Nurses play an essential role in supporting growth in premature infants, focusing on individualized feeding plans, consistent monitoring, and family education. This approach aims to optimize early growth and support overall development, laying a foundation for long-term health.
Sample Citation
Johnson, L., & Carter, T. (2022). Promoting Growth in Premature Infants: A Nursing Approach to Nutrition and Development. Journal of Neonatal Nursing, 40(4), 185-191.