First week weight dip and reaching growth targets in early life in preterm infants
Jorine A Roelants1, Koen F M Joosten2, Brigitte M A van der Geest3
1Department of Pediatrics, Division of Neonatology, Erasmus MC - Sophia Children's Hospital, Wytemaweg 80, 3015 CN Rotterdam, The Netherlands; Department of Obstetrics and Gynecology, Erasmus MC, University Medical Center, Wytemaweg 80, 3015 CN Rotterdam, The Netherlands.
Insights
Adherence to parenteral nutrition guidelines in very preterm infants is key for early growth. While most infants achieved growth targets from maximal weight loss onward, initial energy intake was insufficient.
Area of Science:
- Neonatology
- Pediatric Nutrition
- Growth Monitoring
Background:
- Parenteral nutrition (PN) practices were established over a decade ago to prevent growth retardation in preterm infants.
- Current adherence to these nutritional recommendations and early life growth outcomes require evaluation.
Purpose of the Study:
- To assess adherence to current nutritional recommendations in very preterm infants.
- To evaluate early life growth in this population.
Main Methods:
- Prospective observational cohort study of preterm infants (gestational age <30 weeks, birth weight <1500 g).
- Parenteral and enteral intake data collected on days 1-7, 14, 21, and 28 (d28).
- Growth data collected at birth, maximal weight loss (dip), and discharge/d28; compared to guidelines and a target growth rate of 15-20 g/kg/d.
Main Results:
- Fifty-nine infants included; median gestational age 27 3/7 weeks, birth weight 920 g.
- Median macronutrient intakes met or exceeded targets, but energy targets were not met until day 5.
- Median growth rates were 9.5 g/kg/d (birth to discharge/d28) and 18.1 g/kg/d (dip to discharge/d28).
- Growth targets met by 14% from birth vs. 78% from dip to discharge/d28.
Conclusions:
- Energy intake up to day 5 was below recommendations in this cohort.
- Most infants achieved growth targets, but only when growth was measured from maximal weight loss (dip) onward, not from birth.
Background & Aims:
Aggressive parenteral nutritional practices were implemented in clinical practice over a decade ago to prevent early growth retardation in preterm infants. We aimed to study adherence to current nutritional recommendations in a population of very preterm infants, and to evaluate growth in early life.
Methods:
Preterm infants (gestational age <30 weeks and birth weight <1500 g) were included in a prospective observational cohort study. Data on parenteral and enteral intake were collected on days 1-7, 14, 21 and 28 (d28) of life. Growth data were collected at birth, at moment of maximal weight loss (dip), and either at discharge from the neonatal intensive care unit or at d28, whichever came first. Nutritional intakes were compared to recommendations of current guidelines. The target growth rate was 15-20 g/kg/d.
Results:
Fifty-nine infants (63% male) were included. Median gestational age was 27 3/7 (interquartile range 25 6/7;28 4/7), and birth weight was 920 g (720;1200). Median macronutrient intakes were within or above the targets on all study days, but energy targets were not met before day 5. Median growth rates were 9.5 and 18.1 g/kg/d, when calculated from respectively birth and dip to discharge/d28. Eight (14%) versus 46 (78%) infants met the growth targets, when evaluated from respectively birth and dip to discharge/d28.
Conclusions:
In this cohort, only energy intake up to day 5 was lower than recommended. Growth targets were achieved in the majority of the infants, but only when evaluated from dip onward, not from birth.
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