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Improved nutrition for extremely preterm infants - A population based observational study
Vera Westin1, Susanna Klevebro2, Magnus Domellöf3
1Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden; Function Area Clinical Nutrition, Karolinska University Hospital, Stockholm, Sweden.
Insights
Nutritional support for extremely preterm infants improved significantly in Stockholm between 2004-2011, with increased energy and protein intake leading to better growth. However, many infants still did not reach recommended intake levels.
Area of Science:
- Neonatology
- Pediatric Nutrition
- Intensive Care Medicine
Background:
- Extremely preterm (EPT) infants (<27 weeks gestational age) face high malnutrition risks in neonatal intensive care units (NICUs).
- Nutritional deficits and growth faltering are common challenges during NICU treatment for EPT infants.
- Optimizing nutritional strategies is crucial for EPT infant health and long-term development.
Purpose of the Study:
- To evaluate changes in nutritional intake over the first 56 postnatal days in EPT infants.
- To assess trends in energy and protein intake during NICU treatment.
- To analyze the impact of nutritional interventions on growth in EPT infants.
Main Methods:
- Retrospective analysis of nutrition and growth data from hospital records of 316 EPT infants born between 2004-2011 in Stockholm.
- Daily enteral and parenteral nutrient intake data collected for the first 28 postnatal days, and on specific later days (35, 42, 49, 56).
- Population-based study approach to evaluate changes over an 8-year period.
Main Results:
- Median energy intake increased from 77 to 98 kcal/kg/d and protein intake from 2.4 to 3.6 g/kg/d between 2004-2005 and 2010-2011.
- Continuous increases in energy and protein intake were observed during the first week (postnatal days 0-6) over the study period.
- Earlier achievement of full enteral feeds and a higher proportion of enteral feeds in the first week were noted in later years, correlating with improved growth.
Conclusions:
- Neonatal nutrition significantly improved in Stockholm from 2004 to 2011, with earlier and higher parenteral nutrition provision.
- Despite improvements, many EPT infants did not achieve recommended macronutrient intake levels by the study's end.
- A significant improvement in infant weight gain was observed when comparing the 2004-2005 period to subsequent years (2006-2011).
Background And Aims:
Extremely preterm (EPT) infants are at high risk for malnutrition due to immaturity and medical complications and they often accumulate nutritional deficits and experience growth faltering during treatment at neonatal intensive care units (NICUs). Enhanced intake of energy and protein during the first weeks of life improves weight gain and head circumference growth. The optimal nutritional strategy for these infants' health and long-term development remains unknown. Nutritional regiments have been identified as a potential area for improvement in Swedish NICUs. The aim of this study was to evaluate changes in nutritional intake over time during the first 56 postnatal days in EPT (<27 gestational weeks; n = 316) infants, who were treated in NICUs during 2004-2011 in Stockholm, using a population-based study approach.
Methods:
Several different nutritional interventions were implemented over the 8-year period. Nutrition and growth data were obtained retrospectively from hospital records. All intakes of enteral and parenteral nutrients were retrieved daily during the first 28 postnatal days and on days 35, 42, 49 and 56.
Results:
Energy intake (median) increased from 77 kcal/kg/d during the 2004-2005 period to 98 kcal/kg/d during the 2010-2011 period on days 4-6. Median protein intake increased from 2.4 g/kg/d during 2004-2005 to 3.6 g/kg/d during 2010-2011. Energy and protein intake during postnatal days 0-6 increased continuously over the 8 years and protein intake increased during all 56 postnatal days. Full enteral feeds were reached earlier and the proportion of enteral feeds during the first week was higher during 2008-2009 compared to all other years. A significant improvement in growth was primarily noted by comparing the 2004-2005 period to subsequent years.
Conclusions:
Neonatal nutrition improved significantly in Stockholm from 2004 to 2011. Above all, parenteral nutrition was initiated more promptly during the first week and was provided at higher quantities. However, many of the EPT infants born during the later years still did not reach the recommended macronutrient intake levels. A significant weight gain improvement was observed between 2004-2005 and 2006-2011.
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