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Longitudinal study of energy expenditure in preterm neonates <30 weeks' gestation during the first three postnatal
Karl Bauer1, Maren Laurenz, Jörg Ketteler
1Department of Pediatrics, Universitätsklinikum Benjamin Franklin, Freie Universität Berlin, Germany. karl.bauer@medizin.fu-berlin.de
Insights
Energy expenditure (EE) in preterm neonates under 30 weeks gestation increases steadily after birth. EE can be predicted by energy intake, with no prolonged energy deficit observed in the first three weeks of life.
Area of Science:
- Neonatology
- Pediatric Metabolism
- Infant Physiology
Background:
- Preterm neonates (<30 weeks' gestation) have unique metabolic demands.
- Accurate measurement of energy expenditure (EE) is crucial for optimizing nutritional support in this vulnerable population.
Purpose of the Study:
- To quantify energy expenditure (EE) in a contemporary cohort of preterm neonates (<30 weeks' gestation).
- To assess the relationship between energy intake and EE in early postnatal life.
- To identify potential energy deficits in this population.
Main Methods:
- A prospective longitudinal cohort study involving 26 preterm neonates (gestational age 27 weeks).
- Indirect calorimetry was used to measure EE on postnatal days 1, 3, 5, 10, and 21.
- Body weight, energy intake, and medical therapy were systematically recorded.
Main Results:
- Energy expenditure (EE) significantly increased from day 1 (29 kcal/kg/day) to day 21 (53 kcal/kg/day).
- An energy deficit was observed only on the first postnatal day.
- EE showed a strong positive correlation with energy intake (r = 0.789, P <.0001).
- Neonates <1000 g birth weight did not exhibit a greater energy deficit compared to heavier infants.
- EE was 25% lower during nasal continuous positive airway pressure (nCPAP) compared to spontaneous respiration in the first week.
Conclusions:
- Energy expenditure in preterm neonates (<30 weeks' gestation) can be accurately predicted by energy intake during the first three postnatal weeks.
- Prolonged energy deficits were not observed in this cohort.
- Findings support tailored nutritional strategies based on energy intake for preterm infants.
Objectives:
The objective of this study was to measure energy expenditure (EE) in a contemporary population of preterm neonates <30 weeks' gestation.
Study Design:
Prospective longitudinal cohort study in 26 consecutive preterm neonates (gestational age, 27 weeks [23-29] [median, range]; birth weight, 980 g [554-1592]). EE was measured by indirect calorimetry on postnatal days 1, 3, 5, 10, and 21. Data on body weight, energy intake, and medical therapy were prospectively collected.
Results:
EE increased from 121 +/- 25 kJ/kg per day (29 +/- 6 kcal/kg per day) (mean +/- SD) on day 1 to 222 +/- 25 kJ/kg per day (53 +/- 6 kcal/kg per day) on day 21. An energy deficit occurred only on day 1. EE was closely related to energy intake: For each additional kJ given, EE increased by 0.3 kJ (r = 0.789, P <.0001). Neonates with a birth weight <1000 g did not have a more pronounced energy deficit than the heavier neonates. EE during nasal continuous positive airway pressure in the first postnatal week was 25% lower than during spontaneous respiration.
Conclusions:
EE could be predicted from energy intake with acceptable accuracy in preterm neonates <30 weeks' gestation during the first 3 postnatal weeks. There was no prolonged energy deficit.