Calorie intake is associated with weight gain during transition phase of nutrition in female extremely low birth weight infants

Abstract

We sought to determine whether there are sex-based differences in the requirements for calories or protein for optimal growth during the transition phase (TP) when an extremely low birth weight (ELBW) infant, defined as a preterm infant with a birth weight of < 1000 g, is progressing from parenteral to enteral feeds. A retrospective review of ELBW infants born from 2014 to 2016 was performed at a tertiary NICU. Infants with necrotizing enterocolitis, short bowel syndrome, or chromosomal anomalies were excluded. TP was defined as the period when the infant's enteral feeds were increased from 30 up to 120 ml/kg/day while weaning parenteral nutrition (PN). Effects of sex and protein-calorie intake on the change in growth parameters from the beginning to the end of TP were analyzed. Pre-TP growth percentiles and calorie and protein intake were similar in both sexes. There was a significant (r = 0.22, p = 0.026) correlation of total calorie intake with a change in weight percentiles (wt.pc) for the whole group, but on sex-specific analysis, this correlation was more robust and significant only in girls (r = 0.28, p = 0.015). Protein intake did not correlate with the changes in wt.pc in either sex. Despite a similar intake of calories and protein during the TP, we found a significant decrease in wt.pc only in girls. More extensive studies are needed to understand the sex-based differences in caloric needs and metabolic rate in ELBW infants.

Transition From Parenteral to Enteral Nutrition and Postnatal Growth in Very Preterm Infants During Their First 28 Days of Life

“…The median duration of the TN phase was 10 days, which is consistent with data from previous studies ( 33 ). The older the day of age at the end of the TN phase, the lower the risk of 28-day growth failure, which may be related to lack of enteral protein intake during the TN phase, resulting in a longer period of PN intake.…”

“…Therefore, total protein intake (PN + EN) during the TN can predict growth failure during the neonatal period, while total energy intake has no obvious correlation with growth during the neonatal period. The median duration of the TN phase was 10 days, which is consistent with data from previous studies (33). The older the day of age at the end of the TN phase, the lower the risk of 28-day growth failure, which may be related to lack of enteral protein intake during the TN phase, resulting in a longer period of PN intake.…”

“…Duration of the PN phase, d into early and late stages by an enteral feeding volume of 80 ml/kg/d. The definition of the TN phase remained controversial (13)(14)(15)(16)(17)(18)33). The starting point of the TN can be defined as an enteral feeding volume of 30 ml/kg/d because the progressive reduction of PN always occurred when the enteral feeding volume reached 30 ml/kg/d (after a non-nutritive feeding) (20).…”

Length of Nutritional Transition Associates Negatively with Postnatal Growth in Very Low Birthweight Infants

“…This is in line with previously reported studies that boys seem to benefit more from dietary interventions [26,27]. However, in a study of 95 ELBW infants, a significant correlation of total calorie intake with a change in weight percentiles during the transition phase was reported in girls only [28]. Contrary to our work, this study only included infants appropriate for gestational age.…”

Relationship between nutrient intakes in the transition phase and postnatal growth of preterm infants: a systematic review

“…For the three studies included in this systematic review, the starting point of the TP was relatively uniform, which is the reduction of parenteral nutrition or the volume of enteral feeding up to 30 ml/kg/d, both after minimal enteral feeding; however, the endpoint of the TP is still controversial. Brennan et al [ 15 , 16 ] and Alur et al [ 18 ] considered that the endpoint of the TP was that the volume of enteral feeding reached 120 ml/kg/d and determined that the TP was the key period of massive nutrient deficiency. According to Miller et al [ 13 ] and Liotto et al [ 19 ], the quantitative definition of TP is that enteral feeding volume gradually increases to adequate enteral feeding (160 ml/kg/d) after minimal enteral feeding.…”