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Published on: June 29, 2013
Preventing postnatal growth restriction in infants with birthweight less than 1300 g
M Lapointe1, K J Barrington1,2, M Savaria1
1Division of Neonatology, Sainte-Justine Hospital, Montreal, QC, Canada.
Insights
Enhanced nutrition protocols improved growth outcomes for very preterm infants (BW ≤1300 g). Infants showed better weight gain and fewer were discharged underweight, without increased adverse clinical outcomes.
Area of Science:
- Neonatalogy
- Pediatric Nutrition
- Growth and Development
Background:
- Very preterm infants (birthweight ≤1300 g) often experience suboptimal growth.
- Nutritional support is critical for improving outcomes in this vulnerable population.
Purpose of the Study:
- To evaluate the impact of enhanced enteral and parenteral nutrition protocols on nutritional and growth outcomes.
- To compare outcomes in very preterm infants before and after protocol implementation.
Main Methods:
- Retrospective comparison of two historical cohorts of very preterm infants.
- Analysis of feeding advancement, central line duration, total parenteral nutrition (TPN) use, and nutrient intake.
- Assessment of growth parameters and adverse clinical outcomes, including necrotizing enterocolitis (NEC).
Main Results:
- The enhanced nutrition group (cohort 2) experienced faster feed advancement, reduced central line and TPN duration, and earlier breastmilk fortification.
- Calorie and protein intake were significantly increased in the first 14 days of life for cohort 2.
- The proportion of infants discharged below the 10th percentile weight decreased from 23% to 9%.
- Cohort 2 showed a significantly smaller decrease in body weight z-score compared to cohort 1 (-0.39 vs. -1.03).
- Head circumference and body weight at discharge were significantly improved in cohort 2.
Conclusions:
- Early and enhanced postnatal nutrition, both enteral and parenteral, supports adequate growth in very preterm infants.
- These improved feeding strategies did not increase adverse clinical outcomes like NEC.
- Further optimization of early calorie and protein intake may be beneficial.
Aim:
To examine nutritional and growth outcomes in very preterm infants with a birthweight (BW) of ≤1300 g before and after the introduction of enhanced enteral and parenteral nutrition protocols.
Methods:
A comparison of two historical cohorts.
Results:
There were 153 infants in cohort 1 and 118 in cohort 2. A total of 19% were growth restricted at birth in both cohorts. Feeds advanced more quickly in cohort 2, with decreased duration of central lines and TPN; breastmilk fortification occurred sooner. Calorie and protein intakes were increased during all of the first 14 days of life. Adverse clinical outcomes were unchanged, including NEC. The proportion of infants discharged <10th percentile of expected weight, decreased from 23% to 9%. In cohort 2, the z-score for body weight decreased by 0.39, compared to an average 1.03 in cohort 1 (p < 0.001). Head circumference and body weight were also significantly improved at discharge (p < 0.01), but length was improved to a lesser degree.
Conclusion:
Early and enhanced postnatal intravenous and enteral feeding can provide good postnatal growth among very immature infants without adverse effects. Calorie and particularly protein intake in early life could probably be further optimised.
