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Nutrition Practices and Predictors of Postnatal Growth in Preterm Infants During Hospitalization: A Longitudinal
Briar L McKenzie1, Liza Edmonds2, Ruth Thomson3
1Department of Human Nutrition, University of Otago.
Insights
Premature infants often experience growth issues. Withholding feeds negatively impacts growth, highlighting the need to review early feeding protocols for better outcomes in preterm infants.
Area of Science:
- Neonatalogy
- Pediatric Nutrition
- Growth and Development
Background:
- Premature infants face significant risks of undernutrition and extrauterine growth restriction.
- Early nutrition is critical for optimizing growth and development in vulnerable preterm populations.
Purpose of the Study:
- To investigate the relationship between nutritional practices and growth rates in preterm infants.
- To assess growth from birth to 36 weeks postmenstrual age (PMA) in relation to feeding strategies.
Main Methods:
- Retrospective analysis of longitudinal data from 103 preterm infants (<33 weeks gestation).
- Calculation of z scores for weight, length, and head circumference using INTERGROWTH Preterm Growth Standard.
- Analysis of growth velocity, time to regain birth weight, and nutritional practices, including withholding feeds and enteral nutrition progression.
Main Results:
- Growth faltering increased from 9% at birth to 19% at 36 weeks PMA.
- In-hospital growth velocity (14.2 g·kg·day) was below the recommended rate of 18 g·kg·day.
- Withholding feeds (41% of infants) was linked to longer time to full enteral feeding and poorer weight/length z scores at 36 weeks PMA.
Conclusions:
- Extrauterine growth restriction is prevalent in this preterm infant cohort.
- The negative impact of withholding feeds on growth underscores the importance of evaluating early feeding protocols.
- Further research is needed to understand the long-term effects of feeding practices on postdischarge growth.
Abstract:
Premature infants are at high risk of undernutrition and extrauterine growth restriction.
Aim:
The aim of the study was to evaluate the relation between nutrition practices and growth rate in preterm infants from birth to 36 weeks postmenstrual age (PMA).
Methods:
Longitudinal data were collected retrospectively in 103 infants born <33 weeks gestation admitted to Dunedin Neonatal Intensive Care Unit, New Zealand. Weight, length, and head circumference at birth and 36 weeks PMA z scores were calculated using the INTERGROWTH Preterm Growth Standard. Growth velocity (g · kg · day) was determined via exponential model. Time to regain birth weight and nutritional practices including enteral nutrition, withholding feeds, nutrient intake, and feeding at discharge were described. Regression was used to explore associations between growth and nutritional variables.
Results:
Growth faltering (weight-for-age z score <-1.28/10th centile) increased from 9% at birth to 19% at 36 weeks PMA. Mean (standard deviation) growth velocity in-hospital (14.2 [3.3] g · kg · day) was well below the desirable rate of 18 g · kg · day. Forty-one percent of infants had feeds withheld, which was significantly associated with a longer time period to achieve full enteral feedings (P < 0.001) and poorer weight and length z score at 36 weeks PMA (both P < 0.05). The day of life to establish full enteral feedings was longer than recommended yet positively associated with weight at 36 weeks PMA (P = 0.019), whereas controlling for withholding feeds and other known confounders.
Conclusions:
Extrauterine growth restriction was highly prevalent in this population. The negative association of withholding of feeds on growth reinforces the need to evaluate early life feeding protocols and further assess the longer-term influence of this practice on postdischarge growth outcomes.
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