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Outcome of Very Preterm Infants With Early Optimal Nutrition Strategy: A Comparative Cohort Study
Swati Upadhyay1, Femitha Pournami1, Anand Nandakumar1
1Department of Neonatology, Kerala, Institute of Medical Sciences, Trivandrum, Kerala, India.
Insights
Early optimal nutrition did not significantly improve survival without neurodevelopmental disability (NDD) in preterm infants. However, it reduced risks of necrotizing enterocolitis (NEC) and retinopathy of prematurity (ROP).
Area of Science:
- Neonatalogy
- Pediatric Nutrition
- Neurodevelopmental Outcomes
Background:
- Aggressive nutrition strategies may enhance early growth in preterm infants, but their impact on neurodevelopmental outcomes remains uncertain.
- Neurodevelopmental disability (NDD) is a significant concern in preterm neonates, defined by developmental quotients, screening tests, seizures, or sensory impairments.
- Comparing outcomes before and after implementing early optimal nutrition strategies is crucial for understanding its long-term effects.
Purpose of the Study:
- To compare survival without neurodevelopmental disability (NDD) at 1 year in preterm infants receiving early optimal nutrition versus those receiving standard care.
- To evaluate the effects of early optimal nutrition on various neonatal morbidities, including mortality, bronchopulmonary dysplasia, NEC, ROP, IVH, PVL, sepsis, MBD, and EUGR.
Main Methods:
- A descriptive analytical study comparing two cohorts of preterm neonates (27-32 weeks' gestation): a prospective group (AO) receiving early optimal nutrition and a retrospective group (BO) receiving standard care.
- Both groups were followed until 1 year of corrected age using a structured follow-up plan.
Main Results:
- No statistically significant difference in survival without NDD at 1 year between the early optimal nutrition group (75.5%) and the standard care group (72.1%).
- Infants receiving early optimal nutrition experienced significantly less necrotizing enterocolitis (NEC), extrauterine growth restriction (EUGR), and retinopathy of prematurity (ROP) requiring laser therapy.
- The early optimal nutrition group showed a higher incidence of metabolic bone disease (MBD).
Conclusions:
- Early optimal nutrition strategies did not alter survival without neurodevelopmental disability at 1 year in preterm infants.
- Despite no significant difference in NDD survival, the observed short-term benefits, such as reduced NEC and ROP, may justify the implementation of early optimal nutrition.
Background:
Aggressive nutrition may benefit early growth; nevertheless, effects on neurodevelopmental outcomes are unclear. We planned a descriptive analytical study to compare survival without neurodevelopment disability (NDD) at 1 year in 2 groups during 2 time epochs-before and after implementation of early optimal nutrition strategies. NDD was defined as any one of the following: mental and/or motor development quotient < 85 at 12 months of age, corrected for prematurity; Denver Developmental Screening Test abnormal/suspect in even 1 domain out of the 4 domains; seizures; requirement of hearing aid; or blindness in 1 or both eyes. We also compared mortality, survival without bronchopulmonary dysplasia, necrotizing enterocolitis (NEC), retinopathy of prematurity (ROP), intraventricular hemorrhage, periventricular leukomalacia, sepsis, metabolic bone disease (MBD), and extrauterine growth restriction (EUGR).
Methods:
Preterm neonates born between 27 and 32 weeks' gestation were included. The prospective study group (AO) was recruited after implementation of early optimal nutrition policy. The comparative retrospective cohort (BO) received nutrition based on clinicians' decisions. Both groups were followed up using a structured plan till 1 year corrected age.
Results:
137 neonates were enrolled in AO and 151 in the BO cohort. There was no statistically significant difference in survival without NDD at 1 year-75.5% in AO vs 72.1% in BO, odds ratio 0.84 (95% CI 0.5-1.6). Babies who received early optimal nutrition had less NEC, EUGR, and ROP requiring laser therapy but more MBD.
Conclusion:
There was no difference in survival without NDD in early optimal nutrition cohort compared to the cohort before implementation of the nutrition strategy. Short-term benefits themselves may justify the need for early optimal nutrition.
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