Energy Expenditure in Extremely Low Birth Weight Infants Near Time of Hospital Discharge

Abstract

Objective To test the hypothesis that total energy expenditure would be significantly higher in ELBW infants near discharge compared with healthy term infants. Study design This study was designed to determine total energy expenditure and body composition in a group of ELBW infants nearing discharge on full volume enteral feedings of fortified breast milk or post-discharge formula (Neosure™) (n=10, birth weight 0.8±0.1kg, gestation 26±0.8 wk, age at study 68±9 d, postconceptional age 36±1wk) and compare them with healthy term newborns all receiving breast milk (n=14, birth weight 3.5±0.5 kg, gestation 39.0±1.4 wk, age at study 2.3±1 d). Body composition and total energy expenditure were measured using the doubly labeled water method over a 7 day period. Results The total energy expenditure for ELBW infants was significantly higher than in term infants (89±22 kcal/kcal/kg/day vs. 58±19 kcal/kg/d (p≤0.001)). Total energy expenditure normalized to fat free mass was also significantly greater in ELBW infants (98±3 kcal/kg/d compared with 73±20 kcal/kg/d (p ≤0.01)). Conclusions Rates of total energy expenditure in ELBW infants nearing discharge are greater than normal healthy term infants. Higher energy intakes in the ELBW infants compensated for the higher rates of total energy expenditure in the ELBW infants.

Measuring energy expenditure in clinical populations: rewards and challenges

“…46 The EE of infants can be influenced by other factors, such as birth weight, whether they are breastfed or formula fed and disease state. 46 Studies indicate that low-birth-weight infants have higher total EE than healthy term infants, 47,48 and that spontaneously breathing low-birth-weight infants have higher total EE than ventilated low-birth-weight infants. 49 Feeding practices also influence the total EE of infants such that formula-fed infants have higher total EE during the first year of life than breastfed infants.…”

Stress Oximetry: Description of a Test to Determine Readiness for Discontinuing Oxygen Therapy in Infants with Chronic Lung Disease

“…Infants with CLD also have difficulty in coordinating suck, swallow, and breathing [ 34 , 36 ]. Feeding by mouth may be the most strenuous task undertaken by the newborn infant and is a good indicator of an infant's respiratory reserve [ 35 , 51 ]. Choking during feeds may indeed be a sign of respiratory difficulty in an infant [ 52 ].…”

Relationship between energy expenditure and stress behaviors of preterm infants in the neonatal intensive care unit

“…Our research findings indicate that preterm infants expend more energy when they show sucking, grimaces, or any of five stress behaviors (diffusion squirm, fist, gape face, salute, and sneezing) while receiving nursing interventions. Several studies have also found an assumption that reducing the need for stress or self‐regulatory behaviors in preterm infants may conserve energy for their growth (Hulzebos & Sauer, ; Grenier et al., ; Guilfoy et al., ). Our findings help to verify this assumption.…”

“…In preterm infants, the major component of TEE is near the resting metabolic rate (Denne, ; Hulzebos & Sauer, ). Several studies have demonstrated that the varied, sometimes noxious, stimuli received by preterm infants in the neonatal intensive care unit (NICU) may increase energy expenditure during this medically critical time (Als, ; Guilfoy, Wright‐Coltart, Leitch, & Denne, ; Leitch & Denne, ).…”