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Enhanced feeding in very-low-birth-weight infants may cause electrolyte disturbances and septicemia--a randomized,
Sissel J Moltu1, Kenneth Strømmen, Elin W Blakstad
1Oslo University Hospital HF, Ullevål, Oslo, Norway. sissel.moltu@medisin.uio.no
Insights
Enhanced nutrition for very-low-birth-weight infants improved growth but increased sepsis risk and electrolyte imbalances, suggesting caution with aggressive feeding strategies.
Area of Science:
- Neonatal nutrition and intensive care
- Pediatric gastroenterology and metabolism
Background:
- High protein and energy intake is often given to very-low-birth-weight (VLBW) infants to promote growth and neurodevelopment.
- Optimal feeding strategies for VLBW infants remain a critical area of research in neonatal medicine.
Purpose of the Study:
- To compare the effects of two distinct enteral feeding strategies on the postnatal growth and clinical outcomes of VLBW infants during neonatal hospitalization.
- To evaluate the safety and efficacy of enhanced nutritional support in VLBW infants.
Main Methods:
- A randomized controlled trial involving 50 very-low-birth-weight infants.
- Infants were assigned to either an enhanced or a standard feeding protocol within 24 hours of birth.
- Statistical analyses included Chi-square and T-tests to compare outcomes between groups.
Main Results:
- The enhanced feeding group received significantly higher protein, fat, and energy in the first week (P < 0.001).
- A higher incidence of septicemia was observed in the enhanced group (63% vs. 29%, P = 0.02), leading to study termination.
- Infants on enhanced feeding showed improved postnatal growth but experienced significant electrolyte disturbances, including hypophosphatemia, hypokalemia, and hypercalcemia.
Conclusions:
- Enhanced nutritional support in VLBW infants may lead to electrolyte imbalances, mimicking refeeding syndrome complications.
- The findings suggest potential risks associated with aggressive feeding protocols in this vulnerable population.
- Further research is needed to balance nutritional benefits with potential adverse effects.
Background & Aims:
High supply of protein and energy has been introduced to very-low-birth-weight infants to improve growth and cognitive development. The aim of this study was to compare two different feeding strategies on postnatal growth and clinical outcome during neonatal hospitalization.
Methods:
Fifty very-low-birth-weight infants were randomized to either an enhanced or a standard feeding protocol within 24 h after birth. Chi-square and T-tests were applied.
Results:
First week protein, fat and energy supply was significantly higher in the intervention group compared to the control group (all P < 0.001). After inclusion of 50 patients we observed a higher occurrence of septicemia in the intervention group, 63% vs. 29% (P = 0.02), and no more patients were included. The infants in the intervention group demonstrated improved postnatal growth, but they also disclosed significant electrolyte deviations during the first week of life with hypophosphatemia, hypokalemia and hypercalcemia. First week phosphate nadir was lower in the infants experiencing septicemia (1.23 (0.50) mmol/L) as compared to the infants without (1.61 (0.61) mmol/L) (P = 0.03).
Conclusion:
Our study implies that enhanced feeding may induce electrolyte imbalances in VLBW infants, and that deleterious side effects similar to those seen in refeeding syndrome may occur. ClinicalTrials.gov, number NCT01103219 and the EudraCT number is 2010-020464-38.
