Extrauterine Growth Restriction in Preterm Very Low Birth Weight Infants: The Use of a Web-based System Designed for Computerized Prescribing of Parenteral Nutrition in Neonatal Intensive Care

Abstract

Aim: Extrauterine growth restriction (EUGR) is a multifactorial condition that may lead to long-term consequences for preterm infants. Providing adequate nutrition is one of the keys to ameliorating growth. Technology can help clinicians with powerful tools. We evaluate the impact of a webbased software specifically designed for neonatal parenteral nutrition (PN) prescription on EUGR in a cohort of very low birth weight (VLBW) infants. Materials and methods: We retrospectively analyzed anthropometric measurements (AMs) and comorbidities in a cohort of 119 VLBW infants treated with PN for at least 5 consecutive days. International Fetal and Newborn Growth Consortium for the 21st Century (INTERGROWTH-21st) standards were used to identify small for gestational age (SGA, birth weight < 10th centile) infants and to define EUGR. EUGR was defined as "cross-sectional" (AMs < 10th percentile at discharge) and "longitudinal" (loss in AMs Z-score from birth to discharge > 1 standard deviation [SD]). Results: Nutritional intakes were consistent with current available nutritional guidelines. There were significant differences in the measured incidence of EUGR depending on the adopted definition. The longitudinal definition appeared to be the most appropriate than the cross-sectional one for identifying postnatal growth failure in preterm infants. Lower lipid intake and longer durations of PN were risk factors for poor growth in weight and head circumference (HC). Metabolic disorders, such as cholestasis, hyperglycemia, and hypertriglyceridemia, had stronger links with lower AMs and longer PN needs than just the nutritional intakes. No relationships were observed between the most of comorbidities associated with prematurity and EUGR. Conclusion: A web-based system for the prescription of neonatal PN seems to be useful for ensuring adequate intakes in preterm infants. Further studies with larger sample sizes could be designed for evaluating the application of this software within a neonatal network and its effect on postnatal growth. Clinical significance: The use of an electronic prescribing system designed for neonatal care can help neonatologists in giving VLBW infants the correct intake of nutrients.