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Growth of very premature infants fed intravenous hyperalimentation and calcium-supplemented formula
M A Berry1, H Conrod, R H Usher
1Department of Pediatrics, McGill University, Montreal, Quebec, Canada.
Insights
Very premature infants showed decreased growth in weight, length, and head circumference during hospitalization. Despite calcium-enriched formula, length worsened, though head circumference showed some recovery.
Area of Science:
- Neonatalogy
- Pediatric Nutrition
- Growth and Development
Background:
- Premature infants require specialized nutritional support to optimize growth.
- Intravenous hyperalimentation and specialized preterm formulas are used for very low birth weight infants.
- Assessing growth against intrauterine standards is crucial for evaluating nutritional adequacy.
Purpose of the Study:
- To describe the growth patterns of very small premature infants during initial hospitalization.
- To compare infant growth with intrauterine standards.
- To evaluate the impact of a specific preterm formula and intravenous nutrition on growth.
Main Methods:
- Study included 109 premature infants (<1000 g birth weight, mean gestational age 25.8 weeks).
- Growth parameters (weight, length, head circumference) were measured weekly and compared to intrauterine growth curves.
- Z scores were calculated to quantify deviations from intrauterine standards.
Main Results:
- Infants experienced significant decreases in Z scores for weight, length, and head circumference from birth to 14 days.
- Length Z scores continued to decrease between 14 and 56 days.
- Head circumference Z scores improved after 14 days but remained below birth levels; head-sparing was observed.
Conclusions:
- Infant growth (weight, length, head circumference) at 56 days was poorer than at birth compared to intrauterine standards.
- Relative head-sparing occurred, and weight growth paralleled intrauterine growth after 14 days.
- Length faltered despite calcium and phosphorus-enriched formula, highlighting nutritional challenges.
Objective:
To describe growth during initial hospitalization for very small premature infants fed intravenous hyperalimentation, then calcium supplemented 1460 mg/L (36.5 mmol/L) 81 kcal preterm formula.
Population:
A total of 109 survivors whose <1000 g birth weight was appropriate for gestational age. Mean gestational age was 25.8 weeks.
Results:
Graphs were constructed for weight, length, and head circumference by week of age. Mean and +/- 2 SD lines were depicted, with mean intrauterine growth lines for comparison. Separate graphs showed mean weight, length, and head circumference growth by 100 g birth weight cohorts. Mean Z scores based on normal intrauterine growth curves were calculated. Weight Z scores were -.35 at birth, -1.79 at 14 days, and -1.87 at 56 days. Length Z scores were -.32 at birth, -1.29 at 14 days, and -2.24 at 56 days. Head circumference Z scores were 0.01 at birth, -1.26 at 14 days, and -1.06 at 56 days. (Z score = [measured parameter - intrauterine mean for gestation]/intrauterine SD for gestation). Repeated-measures multivariate ANOVAs showed the following significant Z score changes. There were decreases in Z scores for weight, length, and head circumference between birth and 14 days and an additional decrease for length between 14 and 56 days. Head circumference Z scores increased from day 14 to day 56, but remained smaller at day 56 than at day 0. Initially, head circumference Z scores were better than weight or length (possibly because of late head measurement timing). At day 14, the Z scores for weight were lower than those for length and head circumference. At day 56, the head circumference Z scores were higher than those for length or weight.
Conclusion:
Compared with intrauterine standards, weight, length, and head circumference were all worse at day 56 than at birth, although there was relative head-sparing and weight growth paralleled intrauterine growth after 14 days. Length worsened from day 14 to day 56 in spite of the use of calcium and phosphorus-enriched formula.