A standardized feeding protocol ensured recommended nutrient intakes and prevented growth faltering in preterm infants &lt; 29 weeks gestation

Rossholt, Madelaine Eloranta; Bratlie, Marianne; Wendel, Kristina; Fossan, Marlen; Gunnarsdottir, Gunnthorunn; Fugelseth, Drude; Stiris, Tom; Domellöf, Magnus; Størdal, Ketil; Moltu, Sissel J.

doi:10.1016/j.clnesp.2022.12.024

Cited by 7 publications

(4 citation statements)

References 47 publications

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“…In a 2022 publication from Rossholt et al [ 46 ], close monitoring of growth resulted in only 3% of VPN having >−1 SD deviation from their birth centile at 36 weeks CGA. None of the above studies have recorded any instances of neonates receiving calories or protein in excess of the recommended guidelines.…”

Section: Feeding Policies and Reducing The Percentage Of Vpn With Egrmentioning

confidence: 99%

Extrauterine Growth Restriction and Optimal Growth of Very Preterm Neonates: State of the Art

et al. 2023

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Over the last few decades, there has been an ongoing debate over both the optimal feeding mode for very premature neonates (VPN) as well as what their optimal growth should be. Despite the American Academy of Pediatric declaring since 1997 that the growth of VPN should follow the trajectory of intrauterine fetal growth, differences of opinion persist, feeding policies keep changing, and the growth and development of VPN remains extremely variable not only between countries, but even between neighboring neonatal units. Even the appropriate terminology to express poor postnatal growth (extrauterine growth restriction (EGR) and postnatal growth failure (PGF)) remains a subject of ongoing discussion. A number of recent publications have shown that by implementing breast milk fortification and closely following growth and adjusting nutrition accordingly, as per the consensus guidelines of the major Neonatal Societies, we could achieve growth that closely follows birth centiles. A recent position paper from EPSGAN recommending targeted nutritional support to cover the energy and protein deficits sustained by VPN during periods of critical illness further strengthens the above findings. Conclusion: We can promote better growth of VPN by ensuring a stable administration of sufficient calories and protein, especially in the first 2 weeks of life, implementing breast milk fortification, covering energy and protein deficits due to critical illness, and increasing feeding volumes as per the latest guidelines. The adoption of universal protocol for nutrition and growth of VPN is essential and will enable better monitoring of long-term outcomes for this population.

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Section: Feeding Policies and Reducing The Percentage Of Vpn With Egrmentioning

confidence: 99%

Extrauterine Growth Restriction and Optimal Growth of Very Preterm Neonates: State of the Art

et al. 2023

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“…Besides the potential single-center bias, our analyses are limited by missing data, as for any retrospective study. Nonetheless, this study included over 200 neonates, which is relatively large compared to similar studies on current the ESPGHAN guideline adherence [19,30]. The large cohort together, with a study period of more than 2.5 years, indicates that our population is highly representative for our hospital in particular and for other centers in general.…”

Section: Discussionmentioning

confidence: 95%

A Retrospective Study Evaluating Guideline Adherence of Neonatal Parenteral Nutrition in a Belgian Neonatal Intensive Care Unit

Nguyen,

Meers,

Cortoos

et al. 2024

Cureus

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IntroductionClinical nutrition for preterm and critically ill neonates remains a challenge. Preterms are often hemodynamically and metabolically compromised, which limits infusion volumes of nutrients and hinders achieving recommended nutrient intakes. While guidelines provide recommended ranges for parenteral nutrition (PN) intakes, they generally recommend enteral nutrition as soon as possible. Thus, in clinical practice, gradually increasing EN intakes complicates assessments of PN guideline adherence. Via a pragmatic approach, we assessed adherence to PN recommendations for macronutrients and energy as stated in the 2018 guidelines of the European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN). MethodsIn this retrospective study, we assessed the nutrition of preterm and critically ill term neonates from the neonatal intensive care unit of the University Hospital Brussels. We analyzed intakes for the first week of life, in which critically ill neonates at our center usually receive the majority of nutrients via PN. The PNbased provision of macronutrients and energy was analyzed descriptively in relation to the ESPGHAN 2018 recommendations. ResultsMacronutrients and energy provision gradually increased until they reached recommended or targeted values. Compared to term neonates, energy and lipid provision for preterms increased faster, while amino acid provision exceeded the ESPGHAN 2018 recommendations. ConclusionsThis study adds clinical practice data to the severely understudied field of the ESPGHAN 2018 PN guideline compliance. Using a pragmatic assessment of our nutrition protocols, we found the need to reduce the amount of amino acids per kg body weight per day to meet guideline recommendations.

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“…The nutritional management of the ImNuT cohort followed a standardized feeding protocol to accommodate European guidelines [ 10 , 26 ]. The protocol has been published elsewhere [ 27 ]. Briefly, all infants received a combination of parenteral nutrition (PN) and human milk within a few hours after birth.…”

Section: Methodsmentioning

confidence: 99%

Vitamin A Status in Preterm Infants Is Associated with Inflammation and Dexamethasone Exposure

et al. 2023

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Vitamin A has a key role in lung development and its deficiency is associated with an increased risk of bronchopulmonary dysplasia. This secondary cohort analysis of the ImNuT trial (Immature, Nutrition Therapy NCT03555019) aimed to (1) explore vitamin A status in preterm infants <29 weeks gestation and (2) assess the influence of inflammation and postnatal dexamethasone exposure on vitamin A concentrations in blood. We report detailed information on vitamin A biochemistry, vitamin A intake, markers of inflammation and dexamethasone exposure. After four weeks of age, infants exposed to dexamethasone (n = 39) showed higher vitamin A concentrations compared to unexposed infants (n = 41); median (IQR) retinol was 1.0 (0.74, 1.5) vs. 0.56 (0.41, 0.74) µmol/L, p < 0.001. Pretreatment retinol concentrations were lower in the dexamethasone group compared to non-exposed infants (p < 0.001); 88% vs. 60% of the infants were considered deficient in vitamin A (retinol < 0.7 µmol/L) at one week of age. Small size for gestational age, mechanical ventilation and elevated levels of interleukin-6 were factors negatively associated with first-week retinol concentrations. In conclusion, preterm infants <29 weeks gestation are at risk of vitamin A deficiency despite intakes that accommodate current recommendations. The presence of inflammation and dexamethasone exposure should be considered when interpreting vitamin A status.

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A standardized feeding protocol ensured recommended nutrient intakes and prevented growth faltering in preterm infants < 29 weeks gestation

Cited by 7 publications

References 47 publications

Extrauterine Growth Restriction and Optimal Growth of Very Preterm Neonates: State of the Art

Extrauterine Growth Restriction and Optimal Growth of Very Preterm Neonates: State of the Art

A Retrospective Study Evaluating Guideline Adherence of Neonatal Parenteral Nutrition in a Belgian Neonatal Intensive Care Unit

Vitamin A Status in Preterm Infants Is Associated with Inflammation and Dexamethasone Exposure

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