Preterm Nutrition and Clinical Outcomes

Abstract

Background. In low-income countries, preterm nutrition is often inadequately addressed. The aim of the study was to assess the patterns of feeding and associated clinical outcomes of preterm neonates admitted to neonatal intensive care units in Ethiopia. Method. This was a multicenter, prospective study. Infants’ clinical characteristics at birth, daily monitoring of feeding history, and weight measurements were collected. An outcome assessment was completed at 28 days. Result. For this analysis, 2560 infants (53% male) were eligible. The mean (SD) gestational age was 33.1 (2.2) weeks. During the hospital stay the proportion of infants on breast milk only, preterm formula, term formula, and mixed feeding was 58%, 27.4%, 1.6%, and 34.1%, respectively. Delay in enteral feeding was associated with increased risk of death (odds ratio [OR] = 1.92, 95% confidence interval [CI] = 1.33-2.78; P < .001) and (OR = 5.06, 95% CI = 3.23-7.87; P < .001) for 1 to 3 and 4 to 6 days of delay in enteral feeding, respectively, after adjusting for possible confounders. The length of delay in enteral feeding was associated with increased risk of hypoglycemia (OR = 1.2, 95% CI = 1.1-1.2; P = .005). The mortality rate was lower in hospitals providing preterm formula more often ( P = .04). Half of the infants continued losing weight at the time of discharge. Conclusion. Delayed enteral feeding significantly increases the risk of mortality before discharge and hypoglycemia in preterm infants in resource-limited settings. Ensuring adequate nutritional support of preterm infants is highly needed.

Prematurity: An Overview and Public Health Impacts of Being Born Too Early

“…Enteral feeding of the infants was started on the second and fourth day for 75.7% and 21.8% of the infants respectively. 13 The proportion of infants on breast milk only, preterm formula, term formula and mixed feeding was 58%, 27.4%, 1.6%, and 34.1% respectively. Delay in enteral feeding was associated with increased risk of death, (OR = 1.92, 95% CI 1.33, 2.78) and (OR 5.06, 95% CI 3.23, 7.87, P = .000) for 1 to 3 and 4 to 6 days of delay in enteral feeding respectively after adjusting for possible confounders.…”

“…Delay in enteral feeding was associated with increased risk of death, (OR = 1.92, 95% CI 1.33, 2.78) and (OR 5.06, 95% CI 3.23, 7.87, P = .000) for 1 to 3 and 4 to 6 days of delay in enteral feeding respectively after adjusting for possible confounders. 13 …”

Overview of Important Micronutrients Supplementation in Preterm Infants after Discharge: A Call for Consensus

“…Adequate and timely preterm infant nutritional support has been advocated to avoid malnutrition and limit postnatal growth retardation, thus preventing the need for rapid catch-up growth, which is associated with late adverse metabolic outcomes [ 3 , 4 ]. Increasing evidence indicates that appropriate nutritional management dramatically reduces the risk of comorbidity development, such as sepsis, metabolic bone disease (MBD) and severe retinopathy of prematurity and the optimization of neurodevelopment outcomes [ 5 , 6 ].…”

The Time to Initiate Trophic Feeding and Its Predictors Among Preterm Neonate Admitted to Neonatal Intensive Care Unit, Multicenter Study, Northwest Ethiopia, 2020.

“…These neonates who started enteral feeding was getting only 10% dextrose intravenously. Overall, the neonates were kept NPO in 26.8% of the time while they were in NICU (25).…”

“…The inherent problems of immature gut motility and function as well as the fear of necrotizing enterocolitis and feeding intolerance are the two major reasons that delay the start of preterm feeding (3). This is associated with an increased risk of neonatal mortality (25). There is a marked dose response of increasing risk of neonatal mortality with increasing delay in initiation of breastfeeding.…”