Nutritional practices and postnatal growth restriction in preterm newborns

retrospective study of preterm infants weighing between 500 and 1,499g admitted to NICU. Evolution of growth and parenteral (PN) and enteral (EN) nutrition practices were analyzed.

Results:

among 184 preterm infants divided into G1 (500 to 990g; n=63) and G2 (1000 to 1499g; n=121), 169 received PN (G1=63, G2=106). Compared with the recommendations, PN was started late, its progress was slow and the maximum glucose, amino acid, lipid and energy supplies were low in both groups. The initial supply of amino acid and lipid and initial and maximum glucose and energy were lower in G1. The onset of EN was early (1-2 days), the time to reach exclusive EN was appropriate (11-15 days) and the use of human milk was possible in a reasonable amount of time (7-13 days). The multivariate analysis showed that respiratory distress syndrome and obtaining a supply of 120 kcal/kg/day too late increased the chance of weight loss greater than 10%. Sepsis, maximum energy supply for PN <60 kcal/kg/day and obtaining a supply of 120 kcal/kg/day too late increased the chance of regaining birth weight after 14 days, while small for gestational age (SGA) at birth reduced this chance. SGA at birth, sepsis and achieving exclusive enteral nutrition after 14 days increased the chance of being SGA at post-conceptual age of term.

Conclusion:

improving nutritional practices in the NICU can reduce the growth deficit in premature infants of very low birth weight.

Keywords:
premature; enteral nutrition; parenteral nutrition; very low birth weight

	Group 1 (n=63)	Group 2 (n=121)	p
Gestational age (weeks)	27.7±2.1	30.6±2.2	0.000
Male	25 (39.7%)	66 (54.5%)	0.055
Birth weight (g)	798.2±142.4	1258.3±137.1	0.000
SGA	13 (20.6%)	43 (35.5%)	0.037
Resuscitation in the delivery room	53 (84.0%)	60 (49.6%)	0.000
RDS	37 (58.1%)	35 (28.9%)	0.000
Sepsis	48 (76.1%)	44 (36.3%)	0.000
Necrotizing enterocolitis	12 (19.0%)	11 (9.0%)	0.053
Patent ductus arteriosus	28 (44.4%)	25 (20.6%)	0.001
PIVH	31 (49.2%)	20 (16.5%)	0.000
Bronchopulmonary dysplasia	35 (55.5%)	16 (13.2%)	0.000
Surfactant	34 (53.9%)	30 (24.8%)	0.000
Indomethacin	24 (38.1%)	22 (18.2%)	0.003
Corticoid	3 (4.8%)	3 (1.6%)	0.336
Central venous catheter	42 (66.7%)	34 (28.1%)	0.000
Mechanical ventilation (hours)	264 (24 – 1032)	120 (12 – 1296)	0.000

Days to maximum supply
Parenteral nutrition	Group 1 (n=63)	Group 2 (n=106)	p
Glucose	5 (1 – 26)	4 (1 – 35)	0.283
Amino acids	7 (2 – 33)	6 (2 – 31)	0.106
Lipids	6 (2 – 31)	7 (2 – 38)	0.085
Initial glucose (g/kg/day)	5.8 (1.5 – 10.0)	7.3 (0.3 – 11.5)	0.000
Maximum glucose (g/kg/day)	9.8 (5.7 – 18.2)	13.3 (5.3 – 18.6)	0.000
Initial amino acid (g/kg/day)	0.5 (0.5 – 1.5)	1.0 (0.5 – 2.0)	0.002
Maximum amino acid (g/kg/day)	2.0 (0.5 – 3.5)	2.0 (0.5 – 4.0)	0.967
Initial lipid (g/kg/day)	0.5 (0.5 – 1.0)	0.5 (0.5 – 1.5)	0.001
Maximum lipid (g/kg/day)	2.0 (0.5 – 3.0)	2.0 (0.5 – 3.5)	0.746
Initial energy (kcal/kg/day)	24.9 (10.1 – 42.3)	34.7 (1.0 – 49.1)	0.000
Maximum energy (kcal/kg/day)	51.1 (27.3 – 87.1)	60.1 (27.2 – 96.2)	0.000
Start of PN (days)	2 (1 – 6)	3 (1 – 11)	0.472
Duration of PN (days)	11 (2 – 104)	8.5 (1 – 68)	0.006
Enteral Nutrition	Group 1 (n=63)	Group 2 (n=121)	p
Human milk (days)	13 (1 – 60)	7 (1 – 44)	0.004
Human milk and Formula (days)	14 (1 – 97)	9 (1 – 46)	0.002
Preterm formula (days)	27 (2 – 88)	24 (1 – 64)	0.107
Start of EN (days)	4 (1 – 16)	3 (1 –11)	0.000
Duration of minimum EN (days)	2 (1 – 30)	1 (1 – 15)	0.000
Time for exclusive EN (days)	15 (3 – 42)	11 (5 – 69)	0.001
Duration of EN (days)	44 (1 – 95)	23.5 (7 – 76)	0.000
Time to 120 kcal/kg/day (days)	22 (10 – 52)	15 (7 – 63)	0.000

	OR	95CI	p
Weight loss >10% of birth weight
Respiratory distress syndrome	3.024	[1.385; 6.605]	0.005
>14 days to 120 kcal/kg/day	3.442	[1.517; 7.719]	0.030
> 14 days to regain birth weight
SGA	0.302	[0.127; 0.717]	0.007
Sepsis	2.636	[1.254; 5.540]	0.010
Maximum energy via PN <60 kcal/kg/day	3.029	[1.425; 6.442]	0.004
>14 days to 120 kcal/kg/day	4.551	[1.753; 11.814]	0.001
Small for post-conceptual age of term
SGA at birth	9.995	[2.134; 46.826]	0.004
Sepsis	4.253	[1.496; 12.087]	0.006
>14 days for exclusive EN	6.994	[2.174; 22.501]	0.001

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