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Somatic Growth of Enteral-Only Fed Extremely Low Birth Weight Infants in a Resource-Restricted Setting
Lena Kombo1, Johan Smith1, Lizelle Van Wyk1
1Department of Paediatrics & Child Health, Stellenbosch University, Tygerberg Hospital, Cape Town 7500, South Africa.
Insights
Extra-uterine growth restriction (EUGR) is common in extremely low birth weight (ELBW) infants fed enterally. However, EUGR rates in resource-restricted settings are comparable to well-resourced areas, suggesting optimized enteral nutrition is feasible.
Area of Science:
- Neonatal nutrition
- Pediatric growth studies
- Resource-restricted healthcare
Background:
- Extra-uterine growth restriction (EUGR) is a significant concern for extremely low birth weight (ELBW) infants.
- Nutritional management in resource-restricted (RR) settings presents unique challenges.
- Enteral-only nutrition is often the primary feeding modality in these environments.
Purpose of the Study:
- To determine the incidence and patterns of EUGR in ELBW infants receiving enteral-only nutrition in a RR setting.
- To compare growth outcomes with established international standards (INTERGROWTH-21st).
- To identify factors associated with adequate growth velocity in this population.
Main Methods:
- Retrospective analysis of 72 ELBW infants (<1000g) at Tygerberg Hospital, South Africa.
- Nutritional intake data, primarily from fortified breastmilk, were collected.
- Anthropometric data were compared to INTERGROWTH-21st standards for the first 49 postnatal days.
Main Results:
- Infants reached full enteral feeds (150ml/kg) by Day 10-14, with adequate energy and protein intake achieved subsequently.
- Growth velocity remained below 15g/kg/day through Day 49.
- INTERGROWTH-21st Z-scores declined from -0.8 at birth to -2.4 at Day 49.
- Factors associated with adequate weight gain included maternal hypertension, antenatal steroids, C-section delivery, and SGA status.
Conclusions:
- The incidence of EUGR in this RR setting, using enteral-only nutrition, was similar to that reported in well-resourced settings.
- Despite challenges, achieving fetal growth rates is possible for ELBW infants with optimized enteral feeding.
- Regular auditing of enteral feeding regimens is crucial to ensure optimal protein and energy delivery, balancing growth with the risk of necrotizing enterocolitis.
Aim:
To determine the growth and prevalence of extrauterine growth restriction (EUGR) in extremely low birth weight (ELBW) infants receiving enteral-only nutrition in a resource-restricted (RR) environment.
Methods:
Information on nutritional intake, provided largely from fortified breastmilk, was collected retrospectively for 72 ELBW (<1000 g) infants admitted to Tygerberg Hospital, Cape Town, South Africa over a 1 year period. Anthropometric data for the first 49 postnatal days were compared to gender-specific INTERGROWTH-21st standards.
Results:
Full enteral feeds (150 ml/kg) were reached by Day 10-14 with energy >100 Kcal/kg/day from Day 10, and protein >3.5 mg/kg/day from Day 14, onwards. Growth velocity remained below 15 g/kg/day at Day 49. INTERGROWTH-21st Z-scores decreased from -0.8 ± 1.1 at birth to -2.4 ± 1.5 at Day 49. Adequate weight growth velocity (≥15 g/kg/day) was associated with maternal hypertension, completed antenatal steroids, caesarean section delivery and small for gestational age status.
Conclusion:
This is the first study to evaluate growth of ELBW infants in a RR setting where enteral-only nutrition, principally from fortified breastmilk, was the primary feeding option. The incidence of EUGR, although high, was similar to the incidence in well-resourced settings, where total parenteral nutrition is routinely provided. Lay summaryExtra-uterine growth restriction (EUGR) is high in extremely low birth weight infants receiving enteral-only nutrition. However, EUGR rates are similar to infants receiving parenteral nutrition. Despite developmental immaturity, it is possible for these infants to achieve fetal growth rates. More aggressive feeding and fortification strategies may be necessary and will need to be balanced against the risk and fear of necrotizing enterocolitis. Enteral-only feeding regimens, especially in resource-restricted environments, should be audited regularly to ensure provision of feeds with the most optimal protein, and protein to energy ratios possible.
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