Nutritional assessment of the neonate

Nutritional management decisions, as with most interventions in medicine, are meant to maximize benefit (growth and development) and minimize harm (toxicity). In order to achieve this goal, clinicians require tools that will allow careful monitoring of their patients’ short-and longertermresponses to their nutritional management plan. Past and current research efforts have advanced the science of neonatal nutrition and helped guide present day nutrition strategies. This chapter will provide the clinician a review of those nutritional assessment tools that are currently readily available and also discuss future techniques. Given that the smallest preterm infants (those with birthweights < 1250 g) pose the greatest challenge to clinicians fromnutritionalmanagementandassessment standpoints, the bulk of this chapter will address their specific needs. While this chapter will be divided into medical record review (maternal and neonatal), nutritional intake, laboratory measurements, and anthropometrics, in practice one should consider these concepts concomitantly when assessing the infant. Medical record review The foundation of a sound nutritional assessment plan starts with a comprehensive review of the patient’s medical history. In the case of a neonate, the mother’s medical history must also be considered. Figure 40.1 depicts the various maternal, nutritional, environmental, endocrinological, and fetal factors one must consider when reviewing themedicalandnutritional history.Additional neonatal factors, not included in Figure 40.1, must also be taken into account.