Proactive Enteral Nutrition in Moderately Preterm Small for Gestational Age Infants: A Randomized Clinical Trial

Zecca, Enrico; Costa, Simonetta; Barone, Giuseppe; Giordano, Lucia; Zecca, Chiara; Maggio, Luca

doi:10.1016/j.jpeds.2014.08.065

Cited by 22 publications

(20 citation statements)

References 18 publications

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“…The model of multiple linear regression used to identify factors associated with ΔZ-score w at 36 weeks PCA/DC has a quite poor general coefficient, suggesting that other variables not considered in the analysis may account for explaining the growth outcome in the studied population. Finally, the present investigation was not designed to explore enteral feeding practices in detail in terms of fortification strategies, feeding techniques and breastfeeding polices, which might produce differences in growth outcome, as illustrated by other studies [ 20 , 21 ].…”

Section: Discussionmentioning

confidence: 99%

Nutrition practice, compliance to guidelines and postnatal growth in moderately premature babies: the NUTRIQUAL French survey

Iacobelli¹,

Viaud²,

Lapillonne³

et al. 2015

BMC Pediatr

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BackgroundThe nutritional care provided to moderately premature babies is poorly studied. For a large cohort of such babies, we aimed to describe: nutrition practice intentions, comparison of the intended with the actual practice, compliance of actual practice to current nutrition guidelines, and postnatal growth.MethodsA questionnaire was sent out to 29 neonatal intensive care units in France, in order to address practice intentions. In the same units, retrospective patient’s data were collected to assess actual practice, compliance to nutrition guidelines and infant postnatal growth. The cumulative nutritional deficit during the two first weeks of life was calculated and variables associated with ΔZ-score for weight at 36 weeks postconceptional age/discharge (ΔZ-scorew 36PCA/DC) were analysed by multivariate linear regression.Results276 infants born 30 to 33 weeks of gestation were studied. Among them, 76 % received parenteral nutrition on central venous line after birth. On day of life 1 (DOL1), 93 % of infants had parenteral amino acids (AA), at an intake ≥ 1.5 g/kg in 27 % of cases. Lipids were started at ≤ DOL2 in 47 % of infants. There was a divergence between the intended and the actual practice for both AA and lipids intake. The AA and energy cumulative deficit (DOL1 to DOL14) were respectively 10.9 ± 8.3 g/kg and 483 ± 181 kcal/kg. Weight Z-score (mean ± SD) significantly decreased from birth (−0.17 ± 0.88) to 36 weeks PCA/DC (−1.00 ± 0.82) (p < 0.0001), and the extra-uterine growth retardation (EUGR) rate at 36 weeks PCA/DC was 24.2 %. Independent variables associated with ΔZ-scorew 36PCA/DC were AA cumulative intake and DOL of full enteral feeding.ConclusionsNutrition intake was not in compliance with recommendations, and the rate of EUGR was considerable in this cohort. Efforts are needed to improve adherence to nutrition guidelines and growth outcome of moderately preterm infants.

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Section: Discussionmentioning

confidence: 99%

Nutrition practice, compliance to guidelines and postnatal growth in moderately premature babies: the NUTRIQUAL French survey

Iacobelli¹,

Viaud²,

Lapillonne³

et al. 2015

BMC Pediatr

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“…Studies have shown that preterm FGR infants do not tolerate enteral feeds in the first few days of life (53) but conversely there is evidence that delaying enteral feeds in preterm FGR infants does not confer any protection against feed intolerance or NEC (54). In fact, it may delay establishment of feeds and increase length of stay in the neonatal unit (55).…”

Section: Perinatal Morbiditiesmentioning

confidence: 99%

Neonatal Morbidities of Fetal Growth Restriction: Pathophysiology and Impact

et al. 2019

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Being born small lays the foundation for short-term and long-term implications for life. Intrauterine or fetal growth restriction describes the pregnancy complication of pathological reduced fetal growth, leading to significant perinatal mortality and morbidity, and subsequent long-term deficits. Placental insufficiency is the principal cause of FGR, which in turn underlies a chronic undersupply of oxygen and nutrients to the fetus. The neonatal morbidities associated with FGR depend on the timing of onset of placental dysfunction and growth restriction, its severity, and the gestation at birth of the infant. In this review, we explore the pathophysiological mechanisms involved in the development of major neonatal morbidities in FGR, and their impact on the health of the infant. Fetal cardiovascular adaptation and altered organ development during gestation are principal contributors to postnatal consequences of FGR. Clinical presentation, diagnostic tools and management strategies of neonatal morbidities are presented. We also present information on the current status of targeted therapies. A better understanding of neonatal morbidities associated with FGR will enable early neonatal detection, monitoring and management of potential adverse outcomes in the newborn period and beyond.

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“…Interestingly, infants in the delayed progressive feeding group reached full enteral feeding in fewer days (17 vs. 19, p = 0.02). Another study compared proactive feeding regimen (1st day-100, last day-200 mL/kg/d) with standard regimen (1st day-60, last day-170 mL/kg/d) [63]. The authors reported a significantly better (near to median) change in weight (−0.29 vs. −0.48, p = 0.002) and length (−0.19 vs. −0.45, p = 0.011) z scores among proactive feeding group.…”

Section: Enteral Feed Interventionsmentioning

confidence: 99%

Feeding Interventions for Infants with Growth Failure in the First Six Months of Life: A Systematic Review

Rana

McGrath²,

Gupta

et al. 2020

Nutrients

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(1) Introduction: Current evidence on managing infants under six months with growth failure or other nutrition-related risk is sparse and low quality. This review aims to inform research priorities to fill this evidence gap, focusing on breastfeeding practices. (2) Methods: We searched PubMed, CINAHL Plus, and Cochrane Library for studies on feeding interventions that aim to restore or improve the volume or quality of breastmilk and breastfeeding when breastfeeding practices are sub-optimal or prematurely stopped. We included studies from both low- and middle-income countries and high-income countries. (3) Results: Forty-seven studies met the inclusion criteria. Most were from high-income countries (n = 35, 74.5%) and included infants who were at risk of growth failure at birth (preterm infants/small for gestational age) and newborns with early growth faltering. Interventions included formula fortification or supplementation (n = 31, 66%), enteral feeds (n = 8, 17%), cup feeding (n = 2, 4.2%), and other (n = 6, 12.8%). Outcomes included anthropometric change (n = 40, 85.1%), reported feeding practices (n = 16, 34%), morbidity (n = 11, 23.4%), and mortality (n = 5, 10.6%). Of 31 studies that assessed formula fortification or supplementation, 30 reported anthropometric changes (n = 17 no effect, n = 9 positive, n = 4 mixed), seven morbidity (n = 3 no effect, n = 2 positive, n = 2 negative), five feeding (n = 2 positive, n = 2 no effect, n = 1 negative), and four mortality (n = 3 no effect, n = 1 negative). Of eight studies that assessed enteral feed interventions, seven reported anthropometric changes (n = 4 positive, n = 3 no effect), five feeding practices (n = 2 positive, n = 2 no effect, n = 1 negative), four morbidity (n = 4 no effect), and one reported mortality (n = 1 no effect). Overall, interventions with positive effects on feeding practices were cup feeding compared to bottle-feeding among preterm; nasogastric tube feed compared to bottle-feeding among low birth weight preterm; and early progressive feeding compared to delayed feeding among extremely low birth weight preterm. Bovine/cow milk feeding and high volume feeding interventions had an unfavourable effect, while electric breast pump and Galactagogue had a mixed effect. Regarding anthropometric outcomes, overall, macronutrient fortified formula, cream supplementation, and fortified human milk formula had a positive effect (weight gain) on preterm infants. Interventions comparing human breastmilk/donor milk with formula had mixed effects. Overall, only human milk compared to formula intervention had a positive effect on morbidity among preterm infants, while none of the interventions had any positive effect on mortality. Bovine/cow milk supplementation had unfavourable effects on both morbidity and mortality. (4) Conclusion: Future research should prioritise low- and middle-income countries, include infants presenting with growth failure in the post-neonatal period and record effects on morbidity and mortality outcomes.

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Proactive Enteral Nutrition in Moderately Preterm Small for Gestational Age Infants: A Randomized Clinical Trial

Cited by 22 publications

References 18 publications

Nutrition practice, compliance to guidelines and postnatal growth in moderately premature babies: the NUTRIQUAL French survey

Nutrition practice, compliance to guidelines and postnatal growth in moderately premature babies: the NUTRIQUAL French survey

Neonatal Morbidities of Fetal Growth Restriction: Pathophysiology and Impact

Feeding Interventions for Infants with Growth Failure in the First Six Months of Life: A Systematic Review

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