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Intersite differences in weight growth velocity of extremely premature infants
Irene E Olsen1, Douglas K Richardson, Christopher H Schmid
1Departments of Nutrition, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA. olseni@email.chop.edu
Insights
Nutritional intake, especially protein, significantly impacts weight gain in extremely premature infants across neonatal intensive care units (NICUs). Optimizing nutrition can improve infant growth rates, potentially reaching intrauterine levels.
Area of Science:
- Neonatalogy
- Pediatric Nutrition
- Growth Physiology
Background:
- Extremely premature infants exhibit variable weight growth velocities in neonatal intensive care units (NICUs).
- Factors influencing growth include gestational age, illness severity, and medical interventions.
Purpose of the Study:
- To identify factors contributing to weight growth velocity differences among extremely premature infants in six level III NICUs.
- To determine the impact of nutritional intake on infant growth rates.
Main Methods:
- Studied 564 infants (<30 weeks' gestational age) across 6 NICUs, collecting data on case mix, medical exposures, and nutritional intake.
- Used multiple linear regression to predict weight growth velocity between day 3 and day 28.
- Analyzed the influence of nutritional factors (calories, protein) on growth velocity.
Main Results:
- Significant inter-NICU variation in weight growth velocity was observed.
- Nutritional intake, particularly protein, explained a substantial portion of this variability.
- Increased protein intake was associated with significantly higher growth velocity.
Conclusions:
- Nutritional variation is a key driver of growth differences in extremely premature infants.
- Current caloric and protein intake levels often fall short of recommendations.
- Enhancing nutritional intake, especially protein, may improve growth rates towards intrauterine standards.
Objective:
To explain differences in weight growth velocity of extremely premature infants among 6 level III neonatal intensive care units (NICUs).
Methods:
In 6 NICUs, we studied 564 infants, stratified by gestational age (GA), who were first admissions, survivors, <30 weeks' GA at birth, and in the NICU at least 16 days. Case mix (eg, birth weight, GA, race, illness severity, prenatal steroids), exposure to medical practices/complications (eg, respiratory support, postnatal steroids, necrotizing enterocolitis, infection), and nutritional intake (kcal/kg/d and protein in g/kg/d) were collected and used to predict weight growth velocity between day 3 and day 28 (or discharge, if transferred early) in multiple linear regression models.
Results:
Weight growth velocities varied significantly among the 6 NICUs. Adjustment for case mix and medical factors explained little of this variability, but additional control for calorie and especially protein intake accounted for much of the intersite variability. For the average infant, adjusted growth velocity ranged from 10.4 to 14.3 g/kg/d among the sites studied. The final predictive model, including case mix and medical and nutritional factors, explained 53% of the overall variance in growth velocity. Prolonged (> or =15 days) exposure to postnatal steroids and greater severity of illness both decreased growth velocity. The model predicted that adding 1 g/kg/d protein to the mean intake for our sample would increase growth by 4.1 g/kg/d.
Conclusions:
Variation in nutrition explained much of the difference in growth among the NICUs studied. Mean intake of calories and protein failed to meet recommended levels, and the average growth in only 1 NICU approximated intrauterine growth standards. Increasing nutritional intake into the recommended ranges, in particular of protein, may increase growth of extremely premature infants up to or above intrauterine rates.