Growth and morbidity of extremely preterm infants after early full enteral nutrition

Maas, Christoph; Franz, Axel R.; Krogh, Stefanie von; Arand, Jörg; Poets, Christian F.

doi:10.1136/archdischild-2017-312917

Cited by 36 publications

(35 citation statements)

References 10 publications

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“…Preterm infants of < 32 weeks gestational age were discharged at 35.4 (34.5–36.7) weeks, where it is common practice in Germany to discharge these infants at about 38 weeks ( 15 , 16 ). The preterm infants of the present study were discharged also on average 2 weeks earlier than a recent population of preterm infants of the English Neonatal Research Database ( 17 ).…”

Section: Discussionmentioning

confidence: 99%

Safety and Parental Satisfaction With Early Discharge of Preterm Infants on Nasogastric Tube Feeding and Outpatient Clinic Follow-Up

2020

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Aim: To evaluate our early discharge program of preterm infants with nasogastric tube feeding (NTF) and close outpatient clinic follow-up with regard to safety, parent satisfaction and parental stress level. Methods: 119 preterm infants were discharged on NTF from our tertiary care neonatal unit (median gestational age 31.0 weeks, median birthweight 1,650 g). Parental satisfaction was evaluated by a standardized questionnaire. For safety assessment growth until term equivalent age and re-hospitalizations within 2 months after discharge were evaluated. Results: Infants were discharged home at a median gestational age of 35.4 weeks after a median hospital stay of 22 days. Follow up was attained in 95 of 104 parent-infant dyads. The majority of parents (94%) reported that they had made the right decision in taking their infant home on NTF. At the time of discharge 86% of parents felt very well-prepared to perform NTF. 70% Of parents rated their stress level at home as low (≤2 out of 5). There were no NTF associated readmissions and no growth faltering until term equivalent age. Conclusion: Early discharge of preterm infants with NTF together with outpatient clinic follow-up is very well-accepted by parents and appears to be safe.

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Section: Discussionmentioning

confidence: 99%

Safety and Parental Satisfaction With Early Discharge of Preterm Infants on Nasogastric Tube Feeding and Outpatient Clinic Follow-Up

2020

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“…Optimizing early nutrition is a priority in preterm infants, as suboptimal nutrient intake in the first few weeks of life is associated with adverse effects on long-term growth and neurodevelopment [ 1 , 2 , 3 , 4 , 5 , 6 , 7 ]. Early introduction of feeding is an important strategy in this context, especially in extremely preterm (EP) infants.…”

Section: Introductionmentioning

confidence: 99%

Composition of Coloured Gastric Residuals in Extremely Preterm Infants-A Nested Prospective Observational Study

et al. 2020

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Green gastric residuals (GR) are often considered as a sign of feed intolerance and discarded in preterm infants. Probiotics are known to enhance feed tolerance in preterm infants. To assess the composition (primary outcome) and volume of discarded green GRs, and feeding outcomes in extremely preterm (EP) infants in a probiotic trial, composition of pale and dark green GRs in the first two weeks of life from EP infants (<28 weeks) in a randomized controlled trial (RCT: SiMPro) of single vs. three-strain probiotics was assessed. Feeding outcomes included time to full feeds (TFF: 150 mL/kg/day) and duration of parenteral nutrition (PN). EP infants given placebo in our previous probiotic RCT served as the reference group. Analysis involved linear regression modelling with clustered standard errors for repeated measurements. GRs of 74/103 from 39 SiMPro infants (18: single-strain, 21: three-strain) were analyzed. Bile acid content was higher but statistically insignificant (825.79 vs. 338.1 µmol/L; p = 0.12) in dark vs. pale green GRs. Mean (95% confidence interval) fat, nitrogen, and carbohydrate loss in GRs over the study period was 0.02 g (0.01–0.03), 0.011 g (0.009–0.013), and 0.05 g (0.04–0.06), respectively. Overall, SiMPro infants had shorter median TFF (10 vs. 14 days, p = 0.02) and duration of PN (10 vs. 16 days, p = 0.022) compared with control group infants. Z scores for growth parameters at discharge were comparable. Discarding dark green GRs meant higher loss of bile acids during early enteral nutrition in EP infants. Probiotic supplementation was associated with reduced TFF and duration of PN.

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“…Postnatal growth restriction has been reported to be almost universal in preterm infants in the past , even if the recommended nutritional requirements are achieved . On the other hand, small studies suggest that growth rate close to the foetus growth is achievable changing enteral nutrition practices . Data from large neonatal networks may provide a better picture of the current situation and identify trends and groups at higher risk, which is essential to design further interventional studies.…”

Section: Introductionmentioning

confidence: 99%

Cohort study showed that growth rate increment has not been enough to prevent growth retardation of preterm infants and raised concerns about unbalanced growth

et al. 2019

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Aim: We describe the postnatal weight gain, linear and head growth trends of surviving preterm infants from 2005 to 2017.Methods: Multicentre cohort study, including surviving preterm infants <32 weeks (n = 21 084), from the Spanish Neonatal Network database, without major congenital malformations who were less than 50 weeks postmenstrual age at discharge. Outcomes were weight gain (g/kg/day), linear and head growth (cm/week) and changes in weight, length and head circumference z-scores from birth to discharge. The study period was divided into Results: Weight gain, linear growth and head growth were slightly higher in 2015-2017 than in 2005-2008: 12.2 AE 2.6 to 13.1 AE 2.5 g/kg/day, 0.98 AE 0.6 to 1.03 AE 0.6 cm/ week and 0.76 AE 0.2 to 0.77 AE 0.3 cm/week, respectively. It was associated with a decreased fall in weigh, length and head circumference z-scores from birth to discharge (À1.32 AE 0.9 to À1.01 AE 0.84, À1.38 AE 1.2 to À1.18 AE 1.2 and À0.41 AE 1.2 to À0.33 AE 1.3, respectively).Conclusion: Postnatal growth restriction remained a common complication of prematurity despite some increment over the last years. Growth disproportionality seemed to be worsening as weight gain was increased more than linear growth.

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Growth and morbidity of extremely preterm infants after early full enteral nutrition

Abstract: This cohort of ELGANs showed good weight gain and head growth after early full enteral nutrition. The impact of this feeding practice on neonatal morbidity and long-term outcome remains to be tested in adequately powered randomised trials.

Cited by 36 publications

References 10 publications

Safety and Parental Satisfaction With Early Discharge of Preterm Infants on Nasogastric Tube Feeding and Outpatient Clinic Follow-Up

Safety and Parental Satisfaction With Early Discharge of Preterm Infants on Nasogastric Tube Feeding and Outpatient Clinic Follow-Up

Composition of Coloured Gastric Residuals in Extremely Preterm Infants-A Nested Prospective Observational Study

Cohort study showed that growth rate increment has not been enough to prevent growth retardation of preterm infants and raised concerns about unbalanced growth

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