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A standardized feeding protocol ensured recommended nutrient intakes and prevented growth faltering in preterm
Madelaine Eloranta Rossholt1, Marianne Bratlie1, Kristina Wendel2
1Department of Neonatal Intensive Care, Oslo University Hospital, Norway; Department of Pediatrics and Adolescence Medicine, Oslo University Hospital, Norway; Institute of Clinical Medicine, University of Oslo, Norway.
Insights
A new feeding protocol for preterm infants under 29 weeks gestation improved nutritional intake and growth. This standardized approach supports optimal development and health outcomes in extremely premature babies.
Area of Science:
- Neonatology
- Pediatric Nutrition
- Infant Growth and Development
Background:
- Nutrition is critical for the health and growth of preterm infants.
- Compromised growth in early life can negatively impact long-term health outcomes.
- Standardized feeding protocols aim to optimize nutritional delivery and infant well-being.
Purpose of the Study:
- To evaluate nutritional intakes and growth in infants born before 29 weeks gestation.
- To assess the effectiveness of a newly implemented standardized feeding protocol.
- To ensure nutritional practices align with current guidelines for extremely preterm infants.
Main Methods:
- Secondary analysis of the ImNuT study (NCT03555019).
- Prospective data collection on nutritional intake, growth, and biochemistry up to 36 weeks postmenstrual age (PMA).
- Development and implementation of a standardized feeding protocol to minimize practice variations.
Main Results:
- Infants (median gestational age 26 weeks + 6 days) showed progressive increases in energy and macronutrient intake.
- Parenteral nutrition was weaned by day 11, with exclusive enteral feeds meeting nutritional requirements.
- Growth velocities for weight, length, and head circumference were within target ranges, with minimal growth faltering at 36 weeks PMA.
Conclusions:
- The standardized feeding protocol was well-tolerated in infants <29 weeks gestation.
- Nutrient intakes and growth patterns achieved with the protocol were comparable to recommendations.
- The protocol supports adequate nutrition and growth in extremely preterm infants.
Background & Aims:
Nutrition is a cornerstone of postnatal care to prevent compromised growth and support short- and long-term health outcomes in preterm infants. We aimed to evaluate nutritional intakes and growth among infants <29 weeks gestation after implementation of a standardized feeding protocol.
Methods:
This is an observational cohort secondary analysis of data from the ImNuT study (Immature, Nutrition Therapy, NCT03555019). To reduce variations in nutritional practice and ensure accommodation to current guidelines, we developed a standardized feeding protocol. Detailed information on actual nutritional intakes, growth and biochemistry was prospectively collected and assessed from birth to 36 weeks postmenstrual age (PMA).
Results:
Median (range) gestational age and birth weight were 26+6 (22+6-28+6) weeks and 798 (444-1485) g. Energy and macronutrient intakes progressively increased from birth through transition to exclusive enteral feeds. Parenteral nutrition was weaned at median (IQR) day 11 (9, 14) when nutritional requirements were met by exclusively enteral feeds. Infants exhibited a median (IQR) weight loss of 7.8% (5.7, 11.6) and regained birth weight by day 8 (7, 11). Average velocity in weight, length and head circumference from birth to 36 weeks PMA were in accordance with target growth rates; median (IQR) 15.8 (14.7, 17.7) g/kg/d, 1.1 (0.98, 1.3) cm/week and 0.82 (0.83, 0.89) cm/week. At 36 weeks PMA, only 3% of infants exhibited moderate growth faltering (decline in weigh-for-age z score >1.2 from birth), and none severe.
Conclusions:
In infants <29 weeks gestation, the standardized feeding protocol was well tolerated. Nutrient intakes and growth were close to recommendations.
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