Nutritional Practices and Growth Velocity in the First Month of Life in Extremely Premature Infants

OBJECTIVES: The goals of this study were to describe nutritional practices in the first month of life for a large cohort of extremely low gestational age newborns and to determine the impact of these nutritional practices on growth velocity (GV) over the same period. METHODS: The sample included 1187 infants born at 23 to 27 weeks of gestation, at 14 institutions, between 2002 and 2004. Inclusion criteria included survival until day 28 and weight information for days 7 and 28. GV, expressed as grams per kilogram per day, was calculated for the interval between days 7 and 28. Nutritional practices during the first week and on days 14, 21, and 28 were compared with current nutritional guidelines in the literature. Multivariable logistic regression models estimated the contribution of limited nutrition to limited GV. RESULTS: Protein and fat delivery approximated current nutritional recommendations, whereas carbohydrate and total energy intake delivery did not. Despite this, GV of our study infants exceeded the current guideline of 15 g/kg per day. Nevertheless, we found extrauterine growth restriction (ie, weight for gestational age below the 10th centile) in 75% of the infants at 28 days, compared with only 18% at birth. A GV of 20 to 30 g/kg per day was associated with infants' maintaining or exceeding their birth weight z score, with rates in the upper range for the gestationally youngest infants. Early (day 7) nutritional practices were positively associated with GV measured between days 7 and 28. CONCLUSION: The early provision of nutrients is an important determinant of postnatal growth. Extrauterine growth restriction remains high in extremely premature infants even when they achieve a GV rate within current guidelines.

[1]  S. Bratton.  Early Insulin Therapy in Very-Low-Birthweight Infants , 2009 .

[2]  Christopher R Palmer,et al.  Early insulin therapy in very-low-birth-weight infants. , 2008, The New England journal of medicine.

[3]  N. Räihä,et al.  Effects of Two Different Doses of Amino Acid Supplementation on Growth and Blood Amino Acid Levels in Premature Neonates Admitted to the Neonatal Intensive Care Unit: A Randomized, Controlled Trial , 2008, Pediatrics.

[4]  B. Vohr,et al.  Fluid regimens in the first week of life may increase risk of patent ductus arteriosus in extremely low birth weight infants , 2008, Journal of Perinatology.

[5]  A. Spitzer,et al.  Effects of Two Different Doses of Amino Acid Supplementation on Growth and Blood Amino Acid Levels in Premature Neonates Admitted to the Neonatal Intensive Care Unit: A Randomized, Controlled Trial , 2007, Pediatrics.

[6]  P. Thureen.  The Neonatologist's Dilemma: Catch-up Growth or Beneficial Undernutrition in Very Low Birth Weight Infants—What Are Optimal Growth Rates? , 2007, Journal of pediatric gastroenterology and nutrition.

[7]  R. Ehrenkranz.  Early, aggressive nutritional management for very low birth weight infants: what is the evidence? , 2007, Seminars in perinatology.

[8]  P. Sauer.  Can extrauterine growth approximate intrauterine growth? Should it? , 2007, The American journal of clinical nutrition.

[9]  B. Puppala,et al.  Outcomes of early nutrition support in extremely low-birth-weight infants. , 2006, Nutrition in clinical practice : official publication of the American Society for Parenteral and Enteral Nutrition.

[10]  L. Wrage,et al.  Growth in the Neonatal Intensive Care Unit Influences Neurodevelopmental and Growth Outcomes of Extremely Low Birth Weight Infants , 2006, Pediatrics.

[11]  R. Cooke.  Conventional birth weight standards obscure fetal growth restriction in preterm infants , 2006, Archives of Disease in Childhood - Fetal and Neonatal Edition.

[12]  B. Poindexter,et al.  Early provision of parenteral amino acids in extremely low birth weight infants: relation to growth and neurodevelopmental outcome. , 2006, The Journal of pediatrics.

[13]  B. Poindexter,et al.  Association between fluid intake and weight loss during the first ten days of life and risk of bronchopulmonary dysplasia in extremely low birth weight infants. , 2005, The Journal of pediatrics.

[14]  R. Kimura,et al.  Accuracy of Methods for Calculating Postnatal Growth Velocity for Extremely Low Birth Weight Infants , 2005, Pediatrics.

[15]  R. Clark.  Interneonatal Intensive Care Unit Variation in Growth Rates and Feeding Practices in Healthy Moderately Premature Infants , 2005, Journal of Perinatology.

[16]  R. Cooke.  Postnatal Growth in Preterm Infants: Have We Got it Right? , 2005, Journal of Perinatology.

[17]  R. Kleinman,et al.  Pediatric Nutrition Handbook , 2003 .

[18]  D. Adamkin,et al.  Postnatal Malnutrition of Extremely Low Birth-Weight Infants With Catch-Up Growth Postdischarge , 2003, Journal of Perinatology.

[19]  B. Poindexter,et al.  Growth failure in the preterm infant: can we catch up? , 2003, Seminars in perinatology.

[20]  R. Clark,et al.  Extrauterine growth restriction remains a serious problem in prematurely born neonates. , 2003, Pediatrics.

[21]  C. Schmid,et al.  Intersite differences in weight growth velocity of extremely premature infants. , 2002, Pediatrics.

[22]  Diane M. Anderson.  Nutritional assessment and therapeutic interventions for the preterm infant. , 2002, Clinics in perinatology.

[23]  R. Cooke,et al.  Postnatal malnutrition and growth retardation: an inevitable consequence of current recommendations in preterm infants? , 2001, Pediatrics.

[24]  A. Lucas,et al.  Workshop summary: nutrition of the extremely low birth weight infant. , 1999, Pediatrics.

[25]  C R Bauer,et al.  Longitudinal Growth of Hospitalized Very Low Birth Weight Infants , 1999, Pediatrics.

[26]  T J Cole,et al.  Randomised trial of early diet in preterm babies and later intelligence quotient , 1998, BMJ.

[27]  M. Hack,et al.  Catch-up growth during childhood among very low-birth-weight children. , 1996, Archives of pediatrics & adolescent medicine.

[28]  W. Hay.  Assessing the effect of disease on nutrition of the preterm infant. , 1995, Clinical biochemistry.

[29]  J. Dobbing,et al.  Fetal nutrition and cardiovascular disease in adult life , 1993, The Lancet.

[30]  A. Leviton,et al.  Hydration during the first days of life and the risk of bronchopulmonary dysplasia in low birth weight infants. , 1990, The Journal of pediatrics.

[31]  Y. Brans,et al.  Tolerance of Fat Emulsions in Very Low Birthweight Neonates: Effect of Birthweight on Plasma Lipid Concentrations , 1990, American journal of perinatology.

[32]  O. Brooke.  NUTRITION IN THE PRETERM INFANT , 1983, The Lancet.

[33]  C. Stanley,et al.  Decreased oxygenation and hyperlipemia during intravenous fat infusions in premature infants. , 1980, Pediatrics.

[34]  J. Neu.  Early Insulin Therapy in Very-Low-Birth-Weight Infants , 2009 .

[35]  M. Khashu,et al.  Controversies in the management of hyperglycemia in the ELBW infant. , 2008, Indian pediatrics.

[36]  D. Steward,et al.  Growth patterns of extremely low-birth-weight hospitalized preterm infants. , 2002, Journal of obstetric, gynecologic, and neonatal nursing : JOGNN.

[37]  G. Escobar,et al.  SNAP-II and SNAPPE-II: Simplified newborn illness severity and mortality risk scores. , 2001, The Journal of pediatrics.

[38]  C R Bauer,et al.  Very low birth weight outcomes of the National Institute of Child health and human development neonatal research network, January 1995 through December 1996. NICHD Neonatal Research Network. , 2001, Pediatrics.

[39]  J. Tyson,et al.  Very low birth weight outcomes of the National Institute of Child Health and Human Development Neonatal Research Network, January 1993 through December 1994. , 1998, American journal of obstetrics and gynecology.

[40]  A. Wilkinson,et al.  New birthweight and head circumference centiles for gestational ages 24 to 42 weeks. , 1987, Early human development.

[41]  Fluoride as a nutrient: American Academy of Pediatrics Committee on Nutrition. , 1972, Pediatrics.