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Published on: August 25, 2014
Four-week nutritional audit of preterm infants born <33 weeks gestation
Gemma McLeod1, Jill Sherriff, Elizabeth Nathan
1Centre for Neonatal Research and Education, School of Paediatrics and Child Health, The University of Western Australia and King Edward Memorial Hospital, Perth, Western Australia, Australia. gemma.mcleod@uwa.edu.au
Insights
Accurate preterm infant nutrition requires milk analysis. Routine fortification based on assumed composition may lead to inadequate protein and energy intake, impacting weight gain. Stratified fortification by birth gestation is recommended.
Area of Science:
- Neonatal nutrition
- Pediatric gastroenterology
- Clinical biochemistry
Background:
- Preterm infants require precise nutritional support for optimal growth and development.
- Previous nutritional audits relied on assumed milk composition, potentially leading to inaccuracies.
- Variability in human milk composition necessitates accurate assessment for tailored feeding regimens.
Purpose of the Study:
- To audit protein and energy intakes in preterm infants during the first 28 days of life.
- To compare nutritional assessments using assumed versus analyzed milk composition.
- To evaluate the impact of accurate nutritional intake on infant weight gain and achievement of growth targets.
Main Methods:
- Daily monitoring of parenteral and enteral intakes and weight gain in preterm infants (<33 weeks gestation).
- Macronutrient composition analysis of breast milk for a subset of infants.
- Linear mixed models analysis to determine the relationship between nutrient intake and weight gain.
Main Results:
- Human milk macronutrient composition (protein, fat, lactose, energy) exhibited significant variability.
- Nutritional intakes calculated from measured composition differed substantially from those based on assumed values.
- Protein intake was significantly correlated with infant weight gain velocity.
- Infants born earlier (<28 weeks gestation) experienced delayed growth velocity and greater reliance on parenteral nutrition.
Conclusions:
- Assumed milk composition is inadequate for accurate preterm nutritional assessment and fortification.
- Individualized fortification strategies, potentially stratified by gestational age, are crucial for meeting preterm growth targets.
- Routine milk analysis is essential for precise nutritional auditing and optimizing outcomes for preterm infants.
Aim:
Preterm nutritional audits have previously been conducted using assumed milk composition. We audited protein and energy intakes in the first 28 days of preterm life using both assumed milk composition and milk analysis to assess their effect on weight gain and to determine if the recommended reasonable range of intakes were met.
Methods:
Parenteral and enteral intakes and weight gain were recorded daily for infants (n = 63) born <33 weeks gestation, using assumed milk composition. Macronutrient composition was determined by milk analysis for a subset of infants (n = 36). Linear mixed models analysis was used to assess the influence of energy and protein intakes on weight gain.
Results:
(Data median (range)): Infants (n = 63) gestation and birth weight were 30 (24-32) weeks and 1400 (540-2580) g, respectively. Macronutrient milk composition was variable: protein 16.6 (13.4-27.6) g/L, fat 46.1 (35.0-62.4) g/L, lactose 68.0 (50.9-74.8) g/L, energy 3074 (2631-3761) kJ/L. Intakes based on measured composition differed from assumed. Protein intake was significantly associated with weight gain. Compared to infants with longer gestations, those born <28 weeks gestation were fed lower volumes, were more reliant on parenteral nutrition, took an additional seven days to transition to fortified feeds and median weight gain velocity took a fortnight longer to reach targets.
Conclusion:
Preterm milk composition is variable and routine fortification using assumed composition may result in inappropriate nutrition. Fortification regimens stratified by birth gestation may be necessary to achieve preterm nutrition and growth targets. Milk analysis is required for accurate nutritional audit.
