High energy feeding in small for gestation infants.

Abstract

SUMMARY Seventeen low weight infants with symmetrical growth retardation (no wasting) were entered in a randomised, double-blind comparison of high energy, 3.6 MJ/L (87 kcal/100 ml) v standard energy 2*7 MJ/L (65 kcal/100 ml) feeds given ad libitum during their first three months. Intakes were measured throughout, and energy absorption was determined at home from balance studies at 6 weeks and 3 months of age. Infants on high energy feeds absorbed the same proportion of energy intake but consumed less feed throughout the study. Regulation of feed intake was such that by 2 months of age energy intakes were similar in both groups, though before this time infants on high energy feeds had a higher net energy intake and grew slightly faster. Appetite regulation seems to be present at birth or soon after but is not fully developed for several weeks, and until this time increased energy intake can be imposed by adjusting the energy density of the feed.Small for gestational age infants form the underprivileged section of the neonatal population in terms of growth. Though these small infants, about 10% of all births, undoubtedly include many who have been affected by a restrictive intrauterine influence such as placental insufficiency, most have no clear cause for their small size. Presumably these babies have a genetic reason for being small and often do not achieve supranormal (catch up) growth in early infancy, thus remaining at the bottom end of the growth curves. Small babies cause their mothers anxiety, and when they become small adults may suffer social and reproductive disadvantages. It would be of potential value, therefore, to achieve accelerated growth in infancy in these subjects, in the hope that this would pave the way towards a more nearly average adult size. With this in mind, a study was designed to investigate the effect of increasing the energy density of the diet of a group of small for gestational age infants. This paper reports the effects of such a diet on spontaneous food intake. Subjects and methodsInfants. Seventeen infants who were small for gestational age were studied with their parents' consent. These infants were unavoidably selected in that their mothers did not wish to breast feed them, and a further, deliberate selection was made in that none was underweight due to obvious wasting, confirmed by weight and length ratios and arm anthropometry2 (in no case was any measurement more than 2 SD below the mean for our term infant population). Infants underweight because of wasting were not studied since they generally show good catch up growth. Infants entering the study were randomly allocated to one of two formula milks (see below), which were fed from the second week of life. No infant failed to complete the study. The allocated formula was supplied in ready to feed form, identified by number only, and was given ad libitum for three months. During this period no other feeds were offered. The study was double blind and the randomisation and supply logistics were carried out by a nutritionist w...

Fortified human milk in the small for gestational age neonate

“…In a randomized, double blind study, 8 symmetric SGA (Ponderal index >2) babies fed high energy (87 Cal/ 100ml) had a significantly higher weight gain (250 g/ week vs 202g/week, p<0.05) compared to those given standard energy feeds (65 Cal/100ml). 8 These results are similar to those of the present study, even though the neonates studied were symmetric SGA.…”

Impact of macronutrient supplements on later growth of children born preterm or small for gestational age: A systematic review and meta-analysis of randomised and quasirandomised controlled trials

“…The included infants were born between 1972 and 2018. Three studies included term SGA infants [31][32][33], and the remaining studies included preterm infants. Infants in 13 studies received supplements in hospital [34][35][36][37][38][39][40][41][42][43][44], in 27 studies received supplements postdischarge [24,31,33,, and in 2 studies received supplements both in hospital and postdischarge [32,69].…”

“…Three studies included term SGA infants [31][32][33], and the remaining studies included preterm infants. Infants in 13 studies received supplements in hospital [34][35][36][37][38][39][40][41][42][43][44], in 27 studies received supplements postdischarge [24,31,33,, and in 2 studies received supplements both in hospital and postdischarge [32,69]. Twenty-two studies were conducted up to 2000 [24,31,32,35,37,38,41,[43][44][45][47][48][49][50][51][52]56,60,61,66,69,70], and 20 were conducted in or after 2001 [33,34,36,39,40,42,46,[53]<...>…”

“…Although for many studies, blinding was not possible, e.g., when the intervention was breastfeeding [37,38,[42][43][44], many did not comment on blinding of the outcome assessment. Nearly 15% of the included studies were at high risk of other bias because of imbalance between groups at baseline [31,32,34,57,58], different baseline data in each publication [24], or stopping early [39]. Two studies were at high risk of selection bias because the infants were quasirandomised according to their birth date [59] or last digit of the infant's hospital number [70].…”

Is the Macronutrient Intake of Formula-Fed Infants Greater Than Breast-Fed Infants in Early Infancy?

“…Other studies provide support for this hypothesis. Small for gestation infants fed either a standard formula (65 kcal/100 mL) or calorically dense (87 kcal/mL) formula had similar intakes by two months of age [ 86 ].…”