Nutritional practices and postnatal growth restriction in preterm newborns

Abstract

Objective: to assess the nutritional practices in neonatal intensive care units (NICU) associated with growth retardation in premature (preterm) infants. Methods: retrospective study of preterm infants weighing between 500 and 1,499g admitted to NICU. Evolution of growth and parenteral (PN) and enteral (EN) nutrition practices were analyzed. Results: among 184 preterm infants divided into G1 (500 to 990g; n=63) and G2 (1000 to 1499g; n=121), 169 received PN (G1=63, G2=106). Compared with the recommendations, PN was started late, its progress was slow and the maximum glucose, amino acid, lipid and energy supplies were low in both groups. The initial supply of amino acid and lipid and initial and maximum glucose and energy were lower in G1. The onset of EN was early (1-2 days), the time to reach exclusive EN was appropriate (11-15 days) and the use of human milk was possible in a reasonable amount of time (7-13 days). The multivariate analysis showed that respiratory distress syndrome and obtaining a supply of 120 kcal/kg/day too late increased the chance of weight loss greater than 10%. Sepsis, maximum energy supply for PN <60 kcal/kg/day and obtaining a supply of 120 kcal/kg/ day too late increased the chance of regaining birth weight after 14 days, while small for gestational age (SGA) at birth reduced this chance. SGA at birth, sepsis and achieving exclusive enteral nutrition after 14 days increased the chance of being SGA at post-conceptual age of term. Conclusion: improving nutritional practices in the NICU can reduce the growth deficit in premature infants of very low birth weight.

Analysis of Nutrition Support in Very Low‐Birth‐Weight Infants With Extrauterine Growth Restriction

“…The interruption rate of EN was significantly higher in the EUGR group. The interruption rate of EN in this study was 21.1%, which was lower than that reported by Lima et al (29.9%). EN interruption may be caused by avoidable or unavoidable factors, for example, feeding intolerance (abdominal distension and gastric retention), necrotizing enterocolitis (NEC), surgeries (tracheal intubation and preoperative fasting of retinopathy of prematurity), and examinations (ultrasound and fundus examination) .…”

Parenteral nutrition therapy for neonates: Experience in a tertiary care centre in Sri Lanka

“…Proper nutrition in the early critical period of life plays an important role in growth, long-term health, neurodevelopment and in the healthy retinal development in the baby 8,9 . Early aggressive PN is beneficial and useful in reducing postnatal growth restriction especially in premature small for gestational aged neonates 10 . Therefore PN is lifesustaining, but early establishment of enteral feeding is always preferred to prolonged PN which is associated with many complications 4,5 .…”

Care Given to Newborns Fed by Gastric Tube: Concepts and Practices

“…22 With the survival of very low birth weight infants, there is concern and interest in reducing morbidities, with EN being essential for adequate growth and development. 1 Nutritional management includes the type of food, when EN should begin, speed of dietary volume progression, administration techniques, and food tolerance assessment. 23 Although EN is usually postponed in high-risk neonates, there is little evidence to justify this approach.…”

“…And the volume considered as total enteral nutrition being used from 100ml/kg/day to 180ml/kg/day. 1,24,26,27,[30][31][32] In São Paulo, the protocol used recommends a minimum EN of 10 to 15ml/kg/day which would be 2 to 3ml every 4 or 6 hours for 2 to 5 days progressing from 15 to 20ml/kg /day. 47 The comparison retains relatively the average of the indications in the articles, but still with differences.…”

“…Thus, neonatal nutrition is essential for adequate growth and development of newborns in the Neonatal Intensive Care Unit (NICU). 1 Enteral feeding through gastric tube supplies nutritional and nutritional needs in the impossibility of breastfeeding by immaturity or inability to coordinate suckling, deglutition and breathing of the newborn. [2][3] The gastric tube can be classified according to the place of insertion.…”