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Nutritional intake and growth velocity in preterm extremely low-birthweight infants in Asia: Are we doing enough?
Shilpee Raturi1, Qishi Zheng2,3, Lourdes M Daniel1
1Department of Child Development, KK Women's and Children's Hospital, Singapore.
Insights
Optimizing nutrition in extremely low-birthweight infants is crucial for growth. Higher protein and energy intake improved growth velocity, while morbidities hindered it, leading to extra-uterine growth restriction.
Area of Science:
- Neonatalogy
- Pediatric Nutrition
- Growth Monitoring
Background:
- Extremely low-birthweight (ELBW) infants face significant challenges in achieving adequate growth postnatally.
- Extra-uterine growth restriction is a common complication in preterm infants.
Purpose of the Study:
- To evaluate nutritional practices in preterm ELBW infants.
- To determine the impact of nutrition on growth velocity (GV).
- To compare nutritional interventions and comorbidities in infants with limited versus adequate GV.
Main Methods:
- Prospective cohort study assessing protein and energy intake.
- Growth velocity calculated using an exponential model.
- Univariable analysis to identify risk factors for poor GV.
Main Results:
- Increased protein and energy intake correlated with higher GV at discharge.
- Hypotension, necrotizing enterocolitis (NEC), patent ductus arteriosus, and chronic lung disease were linked to reduced GV.
- Longer time to full enteral nutrition was associated with slower GV.
- The incidence of small-for-gestational-age infants increased significantly by discharge.
Conclusions:
- Nutritional intake in the first 28 days positively influenced GV at discharge.
- Neonatal morbidities adversely affected GV.
- Most preterm ELBW infants exhibited extra-uterine growth restriction, with lower z scores at discharge compared to birth.
Aim:
To describe nutritional practices among preterm extremely low-birthweight (ELBW) infants and their impact on growth and to compare differences in nutritional intervention and comorbidities between those with limited growth velocity (GV < 25th percentile) and those with GV > 25th percentile.
Methods:
A prospective cohort study was conducted to assess total protein and energy intake for week 1, days 14, 21 and 28 of life. Post-natal growth was calculated by measuring GV using an exponential model. Univariable analysis was applied to identify the potential risk factors associated with poor GV at day 28 and at discharge from hospital.
Results:
The median GV from birth to day 28 was 9.84 g/kg/day and 11.87 g/kg/day for GV from birth to discharge. Increased protein and energy intake was associated with higher GV at discharge. Hypotension needing inotropes, necrotising enterocolitis (NEC), patent ductus arteriosus and chronic lung disease were significantly associated with reduced GV at discharge. Infants with NEC, hypotension needing inotropes and sepsis took a significantly longer time to achieve full enteral nutrition. A longer time to attain full enteral feeds was associated with slower GV at discharge. Small-for-gestational-age babies increased from 22% at birth to 66.6% at discharge.
Conclusions:
GV at discharge was positively correlated with increasing protein and energy intake in the first 28 days and adversely affected by the presence of neonatal morbidities. There was strong evidence of extra-uterine growth restriction, with the majority of preterm ELBW infants having lower z scores at discharge compared to at birth.
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