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A nutritional program to improve outcome of very low birth weight infants
Niels Rochow1, Gerhard Fusch, Alexandra Mühlinghaus
1Department of Pediatrics, University of Greifswald, Germany.
Insights
Optimizing nutrition for very low birth weight infants improves postnatal growth. Evidence-based strategies led to faster weight gain and improved outcomes without adverse effects.
Area of Science:
- Neonatalogy
- Pediatric Nutrition
- Growth and Development
Background:
- Infant growth often deviates from intrauterine trajectories due to inadequate caloric intake.
- Standard nutritional schedules may not meet the complex needs of very low birth weight infants.
Purpose of the Study:
- To investigate if modifying standard nutritional schedules impacts postnatal growth in very low birth weight infants.
- To assess the effect of evidence-based nutritional strategies on infant growth and development.
Main Methods:
- A retrospective cohort study comparing a study group (n=123) with a control group (n=115).
- The study group received higher intravenous nutrition, earlier and faster enteral feeding, daily feed adjustments based on growth, and an electronic tracking system.
Main Results:
- The study group achieved higher caloric intake and returned to birth weight faster.
- Infants born <30 weeks were heavier at 36 weeks postmenstrual age; those born <28 weeks had larger head circumference and lower sepsis rates.
Conclusions:
- Optimized early postnatal nutrition and daily milk adjustments enhance infant growth.
- Improved growth was achieved without negative impacts on body composition or neurodevelopmental outcomes.
Background & Aims:
The growth of very low birth weight infants does not match intrauterine trajectories, likely due to inappropriate caloric intake. We therefore investigated whether modification of the standard nutritional schedule can impact postnatal growth.
Methods:
We introduced a set of evidence-based strategies in a study group of infants (n = 123): 1) higher maximum intake of intravenous amino acids and lipids; 2) prioritisation of earlier enteral feeding; 3) faster attainment of full enteral feeds; 4) daily adjustment of enteral feeds according to growth trajectory; and 5) utilisation of an electronic pre-structured prescription ordering system that tracks individual growth and energy intake. These infants were compared with a control group (n = 115) in a pre/post retrospective cohort study.
Results:
The study group achieved a higher caloric intake, attained full enteral feeds 5 days earlier, and returned to their birth weight more rapidly than the control group. At 36 weeks postmenstrual age, infants who had been born at <30 weeks were heavier (Δ260 g) but had a similar percentage fat mass. Those born at <28 weeks had a larger head circumference (Δ1.4 cm) and lower sepsis rate (7.8%).
Conclusions:
Optimization of early postnatal nutrition and daily adjustment of milk intake according to weight gain improved growth, without any unfavourable outcomes for body composition and neurodevelopmental follow-up.
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