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Improving head growth in very preterm infants--a randomised controlled trial I: neonatal outcomes
1School of Reproductive and Developmental Medicine, University of Liverpool, Liverpool, UK.
Insights
Providing higher nutrient amounts (hyperalimentation) did not improve head growth in very preterm infants. Cumulative protein/energy deficits predicted poor head growth, highlighting challenges in preterm infant nutrition.
Area of Science:
- Neonatalogy
- Pediatric Nutrition
- Growth Monitoring
Background:
- Infants born very preterm face significant risks of poor postnatal growth.
- Inadequate nutrition during this critical period can impair brain development and long-term neurodevelopmental outcomes.
Purpose of the Study:
- To assess the feasibility of using hyperalimentation (nutrient intake above recommendations) to enhance nutrition and head growth in preterm infants.
- To investigate the impact of increased macronutrient delivery on growth parameters in extremely preterm neonates.
Main Methods:
- A randomized controlled trial involving 142 infants born before 29 weeks' gestation.
- Infants received either hyperalimentation or standard parenteral and enteral nutrition.
- Growth, including occipitofrontal circumference (OFC), was monitored until 36 weeks postmenstrual age (PMA).
Main Results:
- No significant difference in OFC or other growth variables was observed between hyperalimentation and standard nutrition groups.
- Infants receiving hyperalimentation had higher energy and protein intake, yet 80% experienced a cumulative deficit within 4 weeks.
- A cumulative protein/energy deficit at 4 weeks predicted poor head growth (OFC < -2 SD) at 36 weeks' PMA.
Conclusions:
- Cumulative energy and protein deficits are significant predictors of suboptimal head growth in preterm infants.
- Despite efforts, achieving adequate nutritional intake remains a persistent challenge in the management of preterm neonates.
- This study underscores the critical link between early nutrition and long-term growth outcomes in extremely preterm infants.
Background:
Infants born very preterm are at an increased risk of poor growth in the post-natal period. Poor brain growth in this critical period may result from inadequate nutrition, and has long-term effects on neurodevelopmental outcome.
Aims:
To examine the feasibility of providing macronutrients at amounts above current recommendations (hyperalimentation) to improve nutrition and head growth in preterm infants.
Methods:
142 infants <29 weeks' gestation were randomised to hyperalimented or standard parenteral and enteral nutrition. Growth was monitored from birth to 36 weeks' postmenstrual age (PMA). The primary outcome measure was occipitofrontal circumference (OFC) at 36 weeks' PMA.
Results:
55 infants in the intervention group and 59 infants in the control group survived to 36 weeks' PMA. 11 (16%) infants in the intervention group and 13 (18%) infants in the control group were small for gestational age (SGA). There was no statistically significant difference between the two groups in the primary outcome measure or other growth variables. Babies in the intervention group received significantly more energy and protein, but 80% were still in a cumulative protein/energy deficit at the end of 4 weeks. 20 (24%, p = 0.008) of those in deficit at 4 weeks had an OFC of more than 2 SD below the mean at 36 weeks' PMA, as opposed to none of those not in deficit.
Conclusion:
Cumulative energy/protein deficit is predictive of poor head growth, but the delivery of adequate intakes remains a challenge in the preterm.
