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Nutrition and growth analysis of very low birth weight infants
T R Fenton1, D D McMillan, R S Sauve
1Foothills Hospital, Calgary, Alberta, Canada.
Insights
Very low birth weight infants often experience nutritional deficits despite parenteral and enteral feeding. Smaller infants accrued larger energy deficits, impacting growth patterns compared to standard charts.
Area of Science:
- Neonatal nutrition
- Pediatric growth studies
- Intensive care unit data analysis
Background:
- Optimal nutrition is critical for very low birth weight (VLBW) infants' growth and development.
- Existing growth charts may not accurately reflect growth in VLBW infants receiving modern nutritional support.
- Understanding nutritional intake patterns in VLBW infants is essential for improving outcomes.
Purpose of the Study:
- To analyze the nutritional intake and growth patterns of VLBW infants.
- To compare nutrient delivery via parenteral and oral routes across different birth weight categories.
- To assess energy deficits and growth trajectories in VLBW infants.
Main Methods:
- Prospective data collection from 220 VLBW infants over 2 years.
- Inclusion in the Neonatal Intensive Care Unit Audit Data Base.
- Categorization by birth weight (≤750g, 751-1000g, 1001-1250g, 1251-1500g) for analysis of fluid and energy intake.
Main Results:
- Parenteral nutrition was the initial primary source, but rarely sufficient alone for VLBW infants.
- Earlier introduction of nutrition (parenteral/oral) correlated with higher birth weight.
- Enteral feeding became the main nutritional source by week two for all weight groups.
- Infants accumulated significant energy deficits (3780–5460 kJ) within 50 days, with smaller infants showing larger deficits.
- Growth patterns differed between infants appropriate for gestational age and small for gestational age, and from established growth curves.
Conclusions:
- VLBW infants frequently experience suboptimal nutrition, particularly smaller infants, leading to growth deficits.
- Current nutritional strategies may not meet the high energy demands of VLBW infants.
- Growth assessment in VLBW infants requires consideration of their specific nutritional intake and gestational age.
Abstract:
The growth and nutrition of 220 very low birth weight infants were reviewed after comprehensive data on all infants in the hospital were entered into the Neonatal Intensive Care Unit Audit Data Base for 2 years prospectively. Fluid and energy (parenteral and oral) intakes were compared in four birth weight categories (1, less than or equal to 750 g; 2, 751 to 1000 g; 3, 1001 to 1250 g; 4, 1251 to 1500 g). Parenteral nutrition was the major source of first nutrition for the small infants, but seldom did it alone provide adequate nutrition for very low birth weight infants. The age of the first nutrition (parenteral and/or oral nutrition other than dextrose) decreased with increasing birth weight. The age of the first oral feedings was later for the infants of the lower birth weights but enteral feeding became the major nutrition for all weight categories by the second week of life. During the first 50 days the infants accumulated a deficit of 3780 to 5460 kJ relative to their estimated need of 504 kJ/kg per day, with the smaller infants accumulating a significantly larger deficit. The growth of infants appropriate for gestational age and of infants small for gestational age differed from each other and from the commonly used graph of Dancis et al (J Pediatr. 1948;33:570-572).
