A nutritional program to improve outcome of very low birth weight infants (original) (raw)
Related papers
2012
Objectives: To determine (1) whether prescribed and delivered energy and protein intakes during the first two weeks of life met Ziegler's estimated requirements for Very Low Birth Weight (VLBW) infants, (2) if actual energy during the first week of life correlated with time to regain birth weight and reach full enteral nutrition (EN) defined as 100 kcal/kg/day, (3) if growth velocity from time to reach full EN to 36 weeks' postmenstrual age (PMA) met Ziegler's estimated fetal growth velocity (16 g/kg/day), and (4) growth outcomes at 36 weeks' PMA. Study design: Observational study of feeding, early nutrition and early growth of 40 VLBW infants ≤ 30 weeks GA at birth in three newborn intensive care units NICUs. Results: During the first week of life, the percentages of prescribed and delivered energy (69% [65 kcal/kg/day]) and protein (89% [3.1 g/kg/day]) were significantly less than theoretical estimated requirements. Delivered intakes were 15% less than prescribed b...
Enhanced Feeding and Diminished Postnatal Growth Failure in Very-Low-Birth-Weight Infants
Journal of Pediatric Gastroenterology and Nutrition, 2014
Objective: The aim of the present study was to determine whether an increased supply of energy, protein, essential fatty acids, and vitamin A reduces postnatal growth failure in very-low-birth-weight infants. Methods: Fifty infants with birth weight <1500 g were randomized to an intervention (n ¼ 24) or a control (n ¼ 26) feeding protocol within 24 hours after birth. Forty-four infants were included in the final analysis. This study was discontinued because of an increased occurrence of septicemia in the intervention group. Results: The intervention group had a lower mean birth weight (P ¼ 0.03) and a higher proportion of infants small-for-gestational age (P ¼ 0.04) than the control group. Other baseline characteristics were similar. The median (interquartile range) energy and protein supplies during the first 4 weeks of life were higher in the intervention group: 139 (128-145) versus 126 (121-128) kcal Á kg À1 Á day À1 (P < 0.001) and 4.0 (3.9-4.2) versus 3.2 (3.1-3.3) g Á kg À1 Á day À1 (P < 0.001). The infants in the intervention group regained birth weight faster (P ¼ 0.001) and maintained their z scores for weight and head circumference from birth to 36 weeks' postmenstrual age (both P < 0.001). The median (interquartile range) growth velocity was 17.4 (16.3-18.6) g Á kg À1 Á day À1 in the intervention group and 13.8 (13.2-15.5) g Á kg À1 Á day À1 in the control group (P < 0.001). In line with the improved growth in the intervention group, the proportion of growth-restricted infants was 11 of 23 both at birth and at 36 weeks' postmenstrual age, whereas this proportion increased among the controls from 4 of 21 to 13 of 21 (P ¼ 0.04). Conclusions: Enhanced supply of energy, protein, essential fatty acids, and vitamin A caused postnatal growth along the birth percentiles for both weight and head circumference.
ICAN: Infant, Child, & Adolescent Nutrition, 2015
Background. Optimal nutrition for very low birth weight (VLBW, <1500 grams) preterm infants is critical in the neonatal period. With substantial variation in clinical practice, there is limited data on impact of early nutrition on growth and outcomes. Objective. The purpose of this study was to conduct a quality improvement project evaluating growth and clinical outcomes after implementing standardized enteral feeding guidelines for preterm infants. Methods. Evidence based clinical practice feeding guidelines were developed and implemented for VLBW infants in NICU. Primary outcome measures were (1) the rate of early initiation of enteral feeds (< 5 days of life) and (2) growth outcomes as measured by weight and head circumference from birth to discharge. Secondary outcome measures were total TPN days and rate of cholestasis. Retrospective data prior to initiation of guidelines were compared with data from post-implementation period in logistic and linear regression models. Res...
2021
Background Evidence is insufficient to show whether fortification has any effect on growth in preterm infants after discharge. Objective to verify whether VLBW preterm infants who are supplemented with multicomponent present greater anthropometric measurements than those not supplemented. Study Design Parallel randomized controlled trial. A computer-generated random number table was used to allocate the participants. Participants Preterm infants discharged from the NICU of a University Hospital from northeast, Brazil, weighing less than 1,500 g exclusively breastfed at discharge and followed up until they reached 6 months corrected gestational age. Intervention intervention group received Nestlé® PreNan® formula, fractionated in 2 g of powder, mixed with the mother's milk twice a day. Control group was exclusively breastfed. Follow-up was conducted until the infants reached 6 months corrected gestational age (CGA). Outcomes Growth of the anthropometrics parameters weight, head circumference (HC) and lenth with 6 months of corrected age. Mixed effects model for longitudinal data was used. Interaction according to sex was detected and ajusted. Results Weight gain was significantly higher in the intervention group. This effect was verified only for males (p = 0.001). No statistically significant association was observed between the intervention and the head circumference or length (p = 0.211; 0.597). The weaning rate at the end of follow-up was similar in both groups. Conclusions Breastmilk supplementation may improve the weight gain of very low birthweight preterm infants up to six months corrected gestational age. This effect differed by sex and was considered significant only for males.
Implementation of Nutritional Strategies Decreases Postnatal Growth Restriction in Preterm Infants
PLoS ONE, 2012
Background: Prevention of postnatal growth restriction of very preterm infants still represents a challenge for neonatologists. As standard feeding regimens have proven to be inadequate. Improved feeding strategies are needed to promote growth. Aim of the present study was to evaluate whether a set of nutritional strategies could limit the postnatal growth restriction of a cohort of preterm infants. Methodology/Principal Findings: We performed a prospective non randomized interventional cohort study. Growth and body composition were assessed in 102 very low birth weight infants after the introduction of a set of nutritional practice changes. 69 very low birth weight infants who had received nutrition according to the standard nutritional feeding strategy served as a historical control group. Weight was assessed daily, length and head circumference weekly. Body composition at term corrected age was assessed using an air displacement plethysmography system. The cumulative parenteral energy and protein intakes during the first 7 days of life were higher in the intervention group than in the historical group (530681 vs 300693 kcal/kg, p,0.001 and 2162.9 vs 1563.2 g/kg, p,0.01). During weaning from parenteral nutrition, the intervention group received higher parental/enteral energy and protein intakes than the historical control group (1380658 vs 1090670 kcal/kg; 52.667 vs 42.3610 g/kg, p,0.01). Enteral energy (kcal/kg/d) and protein (g/kg/d) intakes in the intervention group were higher than in the historical group (130611 vs 100613; 3.560.5 vs 2.260.6, p,0.01). The negative changes in z score from birth to discharge for weight and head circumference were significantly lower in the intervention group as compared to the historical group. No difference in fat mass percentage between the intervention and the historical groups was found. Conclusions: The optimization and the individualization of nutritional intervention promote postnatal growth of preterm infants without any effect on percentage of fat mass.
Growth Of Very Low Birth Weight Infants And Its Association With Feeding Regimens
Ibrahim Medical College Journal, 2012
Clinical care of infants with very low birth weight (weighing<1500 gm at birth) in developing countries can be labour intensive and is often associated with a prolonged stay in hospital. Although several studies have shown the benefits of early discharge from the hospital for premature infants, it is still a common practice to delay discharge of these infants until they reach a weight of 2000 gm or more. The present study was undertaken to test the assumption that very low birth weight (VLBW) infants can attain optimum growth at home and to find its association with feeding regimens. This prospective observational study was conducted at Neonatal Outpatient Department, Dhaka Shishu Hospital over a period of 1 year from January 2010 to December 2010. A total of 92 very low birth weight neonates were enrolled during discahrge in the Neonatal Unit of Dhaka Shisu Hospital. Out of these 92 neonates 16 neonates expired while 7, 4 and 1 neonates dropped out in the first, second and third follow up respectively. The neonates after discharge were fed on three types of feeding regimens at home. The feeding regimens were expressed breast milk (EBM), EBM+ infant formula (mixed feeding) and infant formula only).The outcome variable was growth in terms of increase in weight, length and occiputo-frontal circumference (OFC). The other outcome measures were respiratory tract infection (RTI), diarrhoea and anaemia, visit to physician and readmission to hospital for the morbidities they encountered. The neonates were observed up to three consecutive follow-ups from their date of discharge. The median gestational age at birth was 31 weeks. Approximately 57% of the neonates were admitted within 72 hours of birth with median age at admission being 24 hours. Females were slightly higher (54.3%) than the males (45.7%). The mean weight, length and OFC at admission were 1208 gm 39.8 cm and 28.3 cm respectively. The study demonstrated a steady increase of weight, length and OFC of the infants up to a median age of 6 months with mixed and EBM feeding compared to infant formula group. Regarding RTI, diarhoea and anaemia the breast fed group suffered less frequently than the groups fed with infant formula and EBM+infant formula groups. The frequency of visits to physician and hospital admission were significantly lower in the EBM group than the other two groups. Higher frequency of breast feeding reduced the chance of infection and its severity. Infants discharged below1500 gm grew well with exclusive breast milk.
Handbook of Growth and Growth Monitoring in Health and Disease, 2011
Survival of premature newborn has increased, particularly among VLBW infants, mostly due to improved knowledge and technologies in neonatal intensive care. Optimal nutritional support for these high-risk premature infants still remains controversial. There is inadequate evidence to define which strategies ensure adequate growth to optimize neurodevelopmental outcome and prevent cardiovascular or metabolic diseases in adulthood. The American Academy of Pediatrics Committee on Nutrition (1985) sets as a “gold standard” a prompt postnatal resumption of growth to a rate-approximating intrauterine growth because this is believed to provide the best possible conditions for subsequent normal development. An additional aim is to mimic body composition of the age-matched fetus. Current nutritional support received by preterm infants may not prevent EUGR, defined as body weight and length below the 10th percentile expected for fetuses of the same PMA. No evidence justifies the interruption of nutrient support after birth. To prevent catabolism due to nutritional deprivation from the first day of life, VLBW infants should receive appropriate energy and proteins during the transition period from fetal to neonatal life. Current recommendations are to provide early and more aggressive nutritional intake. This practice has resulted in a shorter time to regain birth weight and fewer infants with EUGR. In this chapter, we will review the requirements of energy and protein to prevent deficiencies, recommendations about what is optimal nutrition, and when is the best time to initiate nutritional support for this high-risk population.
Nutrient Intake with Early Progressive Enteral Feeding and Growth of Very Low-Birth-Weight Newborns
Nutrients
Early nutrition is one of the most modifiable factors influencing postnatal growth. Optimal nutrient intakes for very preterm infants remain unknown, and poor postnatal growth is common in this population. The aim of this study was to assess nutrient intake during the first 4 weeks of life with early progressive enteral feeding and its impact on the in-hospital growth of very low-birth-weight (VLBW) infants. In total, 120 infants with birth weights below 1500 g and gestational ages below 35 weeks were included in the study. Nutrient intakes were assessed daily for the first 28 days. Growth was measured weekly until discharge. Median time of parenteral nutrition support was 6 days. Target enteral nutrient and energy intake were reached at day 10 of life, and remained stable until day 28, with slowly declining protein intake. Median z-scores at discharge were −0.73, −0.49, and −0.31 for weight, length, and head circumference, respectively. Extrauterine growth restriction was observed ...
Jornal de Pediatria, 2005
Objective: To evaluate the nutritional status at term of a cohort of newborn babies with birth weights of less than 1,500 g and to correlate this with nutritional practices and clinical variables. Methods: Very low birth weight infants admitted to eight neonatal intensive care units from November 1999 to April 2000 were studied prospectively. The units were defined as Type I if they employed aggressive nutritional support techniques and Type II if other nutritional practices were used. Babies were defined as malnourished if their z-score for weight was less than or equal to 2 on the Canadian Perinatal Surveillance System growth curves. Data was analyzed using multivariate linear regression and logistic regression. The study was approved by the Committee for Ethics in Research. Results: Sixty-three percent (126/200) of the study population were classified as being malnourished at term. Weight at term (corrected gestational age) showed a direct correlation with birth weight, but an indirect correlation with the length of stay, gestational age at birth, time to regain birth weight and CRIB score (p < 0.05). Small for gestational age infants had a 12.19 times greater chance of being malnourished at term. Being born at a Type I unit reduced the risk of malnutrition at term by 2.17 times, male sex reduced this risk by 0.4 times and achieving total enteral nutrition by the 10th day of life reduced it by 1.97 times (p < 0.03). Conclusions: The most effective means of preventing babies being malnourished at term is by encouraging perinatal practices aimed at preventing restricted intrauterine growth, in addition to giving priority to aggressive nutritional management.