Early energy and protein intakes and associations with growth, BPD, and ROP in extremely preterm infants

Klevebro, Susanna; Westin, Vera; Sjöström, Elisabeth Stoltz; Norman, Mikael; Domellöf, Magnus; Bonamy, Anna‐Karin Edstedt; Hallberg, Boubou

doi:10.1016/j.clnu.2018.05.012

Cited by 61 publications

(55 citation statements)

References 32 publications

(28 reference statements)

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“…For this reason, and because the consequences of the energy deficit are cumulative, we quantified the overall energy provided in this period. Previous studies have reported that newborns with BPD have a lower growth rate than those with no BPD and that this difference extends beyond the period of hospital stay (33,34) . In our study, too, the newborns with BPD presented a decrease in the weight gain curve at 1 week of life, with significantly lower z-scores.…”

Section: Discussionmentioning

confidence: 95%

“…Some randomised clinical trials have not observed reduction in BPD with parenteral solutions with a higher energy content (46) or reduction in lung morbidity with early PN or higher energy content (47) , although it might be objected that the sample size in both clinical trials may not be adequate. Klevebro et al, through a cohort study, observe that early provision of energy and protein may reduce postnatal weight loss and risk of BPD in extremely preterm infants (33) .…”

Section: Discussionmentioning

confidence: 99%

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Early energy restriction in premature infants and bronchopulmonary dysplasia: a cohort study

et al. 2020

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Bronchopulmonary dysplasia (BPD) is a multifactor pathology. Animal studies and cohort studies suggest that poor nutrient intake after birth increases the risk of BPD. The objective of the present study was to determine the existence of association between BPD in very low birth weight (VLBW) and energy intake during the first week of life. We recorded in a retrospective cohort study the intake of enteral and parenteral macronutrients during this period by examining the nutritional and clinical history of 450 VLBW newborns admitted to the neonatal intensive care unit. After applying the relevant exclusion criteria, data for 389 VLBW infants were analysed, of whom 159 developed some degree of BPD. Among the newborns with BPD, energy and lipid intake was significantly lower and fluid intake was significantly higher. The energy intake for the 25th percentile in the group without BPD was 1778·2 kJ/kg during the first week of life. An energy intake <1778·2 kJ/kg in this period was associated with a 2-fold increase in the adjusted risk of BPD (OR 2·63, 95 % CI 1·30, 5·34). The early nutrition and the increase of energy intake in the first week of life are associated in our sample with a lower risk of BPD developing.

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Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

Early energy restriction in premature infants and bronchopulmonary dysplasia: a cohort study

et al. 2020

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“…The association of enteral feed initiation within 12 hours after birth with lower weight loss at 3 and 7 days of life suggests the benefits of EN on early neonatal growth. These findings are consistent with previous articles reporting that early EN shortens the time to regain birth weight in very preterm infants <32 weeks' GA. 13,19 Thus, early initiation of EN in moderate-to-late preterm infants may be a key intervention to reduce weight loss.…”

Section: Discussionmentioning

confidence: 99%

“…3,10,11 Among very preterm infants <32 weeks' GA, caloric intake and protein intake have been suggested to be critical factors to promote growth and reduce risk of postnatal weight loss and morbidity. 12,13 These infants have higher baseline recommended intake due to their increased metabolic needs and low reserves. 14 The recommended caloric and protein requirements for preterm infants vary between 110 and 135 kcal/kg/d and 3.0 and 4.5 g/kg/d.…”

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confidence: 99%

Association of Caloric Intake, Protein Intake, and Enteral Feeding Initiation with Weight Gain in Infants Born 32 to 34 Weeks' Gestation

et al. 2019

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Objective To determine the association of caloric intake, protein intake, and enteral feed initiation time in the first 3 days of life with weight loss percentage (%WL) at 7 days among infants born 32 to 34 weeks' gestational age (GA). Study Design This is a retrospective cohort study of 252 infants admitted to a neonatal intensive care unit. Patient data included patient characteristics, daily weight, intake, and method of nutrition in the first 3 days. Multivariate linear regression was used to explore associations between outcome (%WL at day 7 of life) and exposures (caloric intake, protein intake, and enteral feed initiation time) and adjusted for covariates (GA, birth weight, and sex). Results Median 7 days %WL was 2.3% (interquartile range: −5.2, 1.2). Average caloric intake and average protein intake in the first 3 days were 57 kcal/kg/d and 2.3 g/kg/d. In the adjusted linear regression, caloric intake and protein intake (coefficient = 0.03, 95% confidence interval [CI]: −0.06, 0.09 and coefficient = 0.11, 95% CI: −0.36, 2.30) were not associated with %WL at 7 days. Enteral feeds ≤12 hours were associated with less %WL at 7 days of life (Coef = −0.15, 95% CI: −2.67, −0.17). Conclusion Enteral feeds ≤12 hours after delivery is associated with lower %WL at 7 days among preterm infants 32 to 34 weeks' GA.

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“…Changes leading to BPD begin in utero and are affected by antenatal steroids, gestational age, birthweight, gender, maternal inflammation, and maternal BMI . BPD develops over the infant’s first several weeks, influenced by mechanical ventilation, excessive oxygen exposure, postnatal infections, nutrition and growth, and certain medications . These factors and others, share the common connection of propagation of pulmonary inflammation in the fetus and newborn.…”

Section: Hemodynamically Significant Pda and Bpdmentioning

confidence: 99%

Hemodynamically significant patent ductus arteriosus and the development of bronchopulmonary dysplasia

Willis

Weems

2018

Congenital Heart Disease

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Patent ductus arteriosus (PDA) is prevalent in premature newborns and has been linked to the development of bronchopulmonary dysplasia (BPD), a serious pulmonary complication of premature birth. Although a causal relationship has not been proven, the link is greatest among infants born at lower gestational age who are treated with mechanical ventilation in the presence of a large ductal shunt. Despite strong association in epidemiological studies, treatment of a patent ductus arteriosus has not been shown to prevent BPD, and some therapies may increase the risk of BPD. We describe preclinical and clinical data demonstrating the association of a PDA with BPD, highlight the effects of surgical and pharmacological treatment, and explore the implications of recent clinical trials for the management of PDA in the premature newborn.

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Early energy and protein intakes and associations with growth, BPD, and ROP in extremely preterm infants

Abstract: Early provision of energy and protein may reduce postnatal weight loss and risk of morbidity in extremely preterm infants.

Cited by 61 publications

References 32 publications

Early energy restriction in premature infants and bronchopulmonary dysplasia: a cohort study

Early energy restriction in premature infants and bronchopulmonary dysplasia: a cohort study

Association of Caloric Intake, Protein Intake, and Enteral Feeding Initiation with Weight Gain in Infants Born 32 to 34 Weeks' Gestation

Hemodynamically significant patent ductus arteriosus and the development of bronchopulmonary dysplasia

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