Nutrition Practices and Predictors of Postnatal Growth in Preterm Infants During Hospitalization

McKenzie, Briar; Edmonds, Liza; Thomson, Ruth; Haszard, Jillian J.; Houghton, Lisa A

doi:10.1097/mpg.0000000000001747

Cited by 25 publications

(28 citation statements)

References 33 publications

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“…When feedings are interrupted or decreased owing to large gastric residuals, growth may be negatively affected. 38 Because of the association between adequate growth and improved neurodevelopmental outcome in extremely preterm infants, these findings may be particularly important. [39][40][41] Large gastric residuals have traditionally been considered an early symptom of NEC, 6 but we found no differences in incidence of NEC between the residual and no residual groups.…”

Section: Discussionmentioning

confidence: 99%

Effect of Gastric Residual Evaluation on Enteral Intake in Extremely Preterm Infants

et al. 2019

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IMPORTANCE Evaluating prefeed gastric residuals is considered routine care but has little supporting evidence. OBJECTIVE To determine the effect of omitting prefeed gastric residual evaluation on nutritional outcomes in extremely preterm infants. DESIGN, SETTING, AND PARTICIPANTS This single-center randomized clinical trial compared the omission of gastric residual evaluation with prefeed gastric residual evaluation. Infants were recruited from a level 4 neonatal intensive care unit and were enrolled from October 17, 2013, to October 8, 2016, and then followed up for 6 weeks after birth. Eligible participants were infants born at 32 or fewer weeks' gestation with a birth weight of 1250 g or less; they were enrolled within 72 hours after birth and within 24 hours after feeding initiation. All participants (N = 143) were included in the modified intent-to-treat analysis, which was conducted from March to July 2018. INTERVENTIONS The residual group underwent prefeed gastric residual evaluation; the no residual group did not. Feeding decisions were made according to nutritional guidelines, and infants received only human milk. MAIN OUTCOMES AND MEASURES The primary outcome was weekly enteral nutrition intake in mL/kg for 6 weeks after birth. RESULTS Of 143 infants, 74 (51.7%) were randomized to undergo gastric residual evaluation (residual group) and 69 (48.3%) to omitted gastric residual evaluation (no residual group). The residual group comprised an even number of male and female infants (37 [50.0%]) with a mean (SD) gestational age of 27.1 (2.4) weeks and a mean (SD) birth weight of 888.8 (206.6) grams, whereas the no residual group had more male infants (36 [52.17%]), a mean (SD) gestational age of 27 (1.2) weeks, and a mean (SD) birth weight of 915.2 (180) grams. The no residual group had feedings that advanced more quickly compared with the residual group (mean weekly increase, 20.7 mL/kg/d vs 17.9 mL/kg/d; P = .02) and consumed more feedings at weeks 5 (137.2 [95% CI, 128.6-145.8]; P = .03) and 6 (141.6 [95% CI, 133.2-150.0]; P = .03). Among the secondary outcomes, the no residual group had higher mean estimated log weights (7.01 [95% CI, 6.99-7.02] vs 6.98 [95% CI, 6.97-7.00]; P = .03), had fewer episodes of abdominal distention (0.59 [95% CI, 0.34-1.01] vs 1.79 [95% CI, 1.27-2.53]; P = .001), and were discharged 8 days earlier (4.21 [95% CI, 4.14-4.28] vs 4.28 [95% CI, 4.19-4.36]; P = .01). Odds for necrotizing enterocolitis (0.058 [95% CI, 0.018-0.190] vs 0.026 [95% CI, 0.006-0.109]), death (0.004 [95% CI, 0.0003-0.046] vs 0.012 [95% CI, 0.001-0.131]), late-onset sepsis (0.970 [95% CI, 0.67-1.40] vs 1.38 [95% CI, 0.97-1.94]), and ventilator-associated pneumonia (0.084 [95% CI, 0.033-0.214] vs 0.056 [95% CI, 0.019-0.168]) were similar between groups. CONCLUSIONS AND RELEVANCE Among extremely preterm infants, the omission of gastric residual evaluation increased the delivery of enteral nutrition as well as improved weight gain and led to earlier hospital discharge; these results may translate into evidence-ba...

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Section: Discussionmentioning

confidence: 99%

Effect of Gastric Residual Evaluation on Enteral Intake in Extremely Preterm Infants

et al. 2019

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“…Even though improvement of postnatal growth and identification of risk factors was one of our aims, the major focus of our paper was to reflect on how different approaches to analyzing postnatal growth can result into confusing and even inaccurate conclusions. Current reported percentages of EUGR are indeed heterogeneous, and range from around the figure in their referenced paper of 25% [2][3][4][5] to others more in line with our prevalence of 40-60% [6][7][8]. Nevertheless, and this was one of the points we were trying to highlight, interpretation must be cautious, because the definitions of EUGR are different, or applied at different time points, or over populations with different prevalence of IUGR or different gestational ages.…”

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confidence: 69%

“…Upper limits recommended by the World Health Organization [30] and ESPGHAN [31] are around 180-200 mL/kg/day, and that is reflected in our protocol. Nevertheless, these volumes were not met, either because of the low prescription by clinicians [32], or due to feeding intolerance, a major problem in preterm enteral nutrition, with up to 40% of infants receiving less milk than initially intended [4]. Incidentally, this seems to be even more of a challenge in the smallest preterm infants and those on non-invasive respiratory support, who tend to develop "CPAP belly syndrome" [33].…”

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confidence: 99%

Reply: “It is Time for a Universal Nutrition Policy in Very Preterm Neonates during the Neonatal Period? Comment on: Applying Methods for Postnatal Growth Assessment in the Clinical Setting: Evaluation in a Longitudinal Cohort of Very Preterm Infants Nutrients 2019, 11, 2772”

et al. 2020

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“…The choice of an appropriate method of growth assessment is important both for clinical practice and research. Postnatal growth is used to guide day-to-day decisions, such as determining the feeding regimen of preterm infants [22]. The lack of standardization of methods of growth assessment makes comparisons between studies difficult and represents an obstacle for the translation of results from research studies into improved clinical guidelines.…”

Section: Discussionmentioning

confidence: 99%

Neonatal growth velocity of preterm infants: The weight Z-score change versus Patel exponential model

et al. 2019

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Background Different methods are used to assess the growth of preterm infants during neonatal hospital stay. The primary objective was to compare two methods for assessing growth velocity: g/kg/d according to the Patel exponential model (EM) and change in weight z-score (ZS) according to Fenton curves. The secondary objective was to highlight factors influencing the level of agreement between the two methods. Methods Preterm infants born before 33 weeks were included. Growth velocity was computed by EM and ZS methods and linear regression was used to predict what growth velocity by EM method would be obtained using the ZS method. Differences between EM growth velocity and EM growth velocity predicted by ZS method were then used to assess the level of agreement between the two methods. A difference between -2 and +2 g/kg/day was considered as fair agreement, greater than ± 4 g/kg/day as poor agreement, and as disagreement otherwise. Results Among the 3954 children included, we observe a fair agreement in 2471 children (62.5%), a poor agreement in 1278 (32.3%) and a disagreement in 205 children (5.2%). Birth weight and gestational age explained 31% and 25%, respectively, of the variance in the difference between the two methods. Conclusions In more than a third of enrolled children, the two methods for measuring growth velocity disagreed substantially. As variation of weight Z-score takes into account infant gestational age and gender, it could be more suitable to analyze a population of preterm infants with a wide range of gestational age.

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Nutrition Practices and Predictors of Postnatal Growth in Preterm Infants During Hospitalization

Abstract: Extrauterine growth restriction was highly prevalent in this population. The negative association of withholding of feeds on growth reinforces the need to evaluate early life feeding protocols and further assess the longer-term influence of this practice on postdischarge growth outcomes.

Cited by 25 publications

References 33 publications

Effect of Gastric Residual Evaluation on Enteral Intake in Extremely Preterm Infants

Effect of Gastric Residual Evaluation on Enteral Intake in Extremely Preterm Infants

Reply: “It is Time for a Universal Nutrition Policy in Very Preterm Neonates during the Neonatal Period? Comment on: Applying Methods for Postnatal Growth Assessment in the Clinical Setting: Evaluation in a Longitudinal Cohort of Very Preterm Infants Nutrients 2019, 11, 2772”

Neonatal growth velocity of preterm infants: The weight Z-score change versus Patel exponential model

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