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Randomised controlled trial of an aggressive nutritional regimen in sick very low birthweight infants
D C Wilson1, P Cairns, H L Halliday
1Royal Maternity Hospital, Belfast, Northern Ireland.
Insights
Aggressive nutritional support for sick very low birthweight (VLBW) infants improves early growth without increasing morbidities. This enhanced nutrition strategy led to better growth outcomes but did not reduce hospital stay or pulmonary issues.
Area of Science:
- Neonatal intensive care
- Pediatric nutrition
- Clinical research
Background:
- Sick very low birthweight (VLBW) infants face significant growth challenges and feeding-related morbidities.
- Common morbidities include bronchopulmonary dysplasia, necrotising enterocolitis, septicaemia, cholestasis, and osteopenia of prematurity.
Purpose of the Study:
- To enhance energy intake in sick VLBW infants.
- To reduce growth problems, pulmonary morbidity, and hospital stay.
- To prevent feeding-related morbidities in VLBW infants.
Main Methods:
- A prospective randomized controlled trial (RCT) involving 125 sick VLBW infants.
- Comparison of an aggressive nutritional regimen (Group A) versus a conservative regimen (Group B).
- Statistical analysis included Student's t test, Mann-Whitney U test, chi-squared test, and logistic regression.
Main Results:
- Group A showed significantly higher mean energy intakes during parenteral nutrition (days 3-42).
- Infants in Group A experienced significantly better early-life and discharge growth.
- Survival and incidences of major morbidities (bronchopulmonary dysplasia, necrotising enterocolitis, etc.) were similar between groups.
Conclusions:
- Improved nutritional intake in sick VLBW infants is achievable without increasing adverse clinical or metabolic risks.
- Enhanced nutrition positively impacts growth but does not decrease pulmonary morbidity or hospital stay.
- Aggressive nutritional strategies can be safely implemented to improve growth outcomes in VLBW infants.
Aims:
To improve energy intake in sick very low birthweight (VLBW) infants; to decrease growth problems, lessen pulmonary morbidity, shorten hospital stay, and avoid possible feeding related morbidity. Morbidity in VLBW infants thought to be associated with parenteral and enteral feeding includes bronchopulmonary dysplasia, necrotising enterocolitis, septicaemia, cholestasis and osteopenia of prematurity.
Methods:
A prospective randomised controlled trial (RCT) comparing two types of nutritional intervention was performed involving 125 sick VLBW infants in the setting of a regional neonatal intensive care unit. Babies were randomly allocated to either an aggressive nutritional regimen (group A) or a control group (group B). Babies in group B received a conservative nutritional regimen while group A received a package of more aggressive parenteral and enteral nutrition. Statistical analysis was done using Student's t test, the Mann-Whitney U test, the chi 2 test and logistic regression.
Results:
There was an excess of sicker babies in group A, as measured by initial disease severity (P < 0.01), but mean total energy intakes were significantly higher (P < 0.001) in group A at days 3 to 42 while receiving total or partial parenteral nutrition. Survival and the incidences of bronchopulmonary dysplasia, septicaemia, cholestasis, osteopenia and necrotising enterocolitis were similar in both groups. Growth in early life and at discharge from hospital was significantly better in babies in group A. There were no decreases in pulmonary morbidity or hospital stay.
Conclusion:
Nutritional intake in sick VLBW infants can be improved without increasing the risk of adverse clinical or metabolic sequelae. Improved nutritional intake resulted in better growth, both in discharge, but did not decrease pulmonary morbidity or shorten hospital stay.