Aggressive Nutrition Strategy Boosts Premature Infant Growth

An aggressive nutrition protocol in extremely low birth weight (ELBW) infants promotes marked improvement of postnatal growth.

Researchers at the Medical University of Vienna (MedUni, Austria) conducted a retrospective analysis study in ELBW infants who were nourished using a conservative (77 infants) or aggressive (85 infants) nutritional regimen that differed in the composition of parenteral nutrition (PN) after birth, as well as the composition and timing of advancement of enteral feeds (EF). The researchers then analyzed the incidence of PN associated cholestasis (PNAC), corrected for cholestasis, growth until discharge, and neonatal morbidities.

The results revealed that the infants fed with the aggressive nutritional regimen weighed 500 grams more at the time of their subsequent discharge from hospital--2.5 kg, compared to an average 2 kg with conventional nutrition--and they also gained a centimeter more in head circumference and height than other premature babies who had been conventionally fed. The incidence of PNAC was also significantly lower during the period of aggressive nutrition. The study was published on September 20, 2016, in PeerJ.

“Previously we have been extremely careful with the feeding of these tiny premature babies, for fear of causing enteritis. However, our data analysis shows that a new, strategy, based on recent international studies, is much more successful,” said lead author Andreas Repa, MD, of the department of pediatrics and adolescent medicine. “The body mass index at discharge was significantly higher using aggressive nutrition and growth became more proportionate, with significantly less infants being discharged below the 10th BMI percentile.”

The nutritional needs of premature infants are usually dependent upon PN during early postnatal life, especially infants weighing of less than 1,500 grams. In these infants, full enteral feedings are generally delayed because of the severity of medical problems associated with prematurity. The early use of adequate PN minimizes weight loss, improves growth and neurodevelopmental outcome, and appears to reduce the risk of mortality and later adverse outcomes, such as necrotizing enterocolitis and bronchopulmonary dysplasia. Increased protein and energy intakes in the first week of life also are associated with improved neurodevelopmental outcome.

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