Objective: To compare postnatal growth and nutritional deficits after the implementation of two different nutritional strategies in two consecutives periods of time.Methods: An early and aggressive nutritional regimen was used in a cohort of 117 very low birth weight (VLBW) infants. Amino acids were administered at the rate of 1.5 g/kg/day along with 5.6 mg/k/min of glucose flow on day 1 of life, and progressively increased to 4 g/kg/day and 13 mg/kg/min. Intravenous lipids were started at 0.5 g/kg/day at 24 h from birth, and increased to 3.5 g/kg/day; enteral feeding was begun at day 1 of life. Uni-and multivariate analyses were used to compare this group with the conventional group of 65 VLBW infants conservatively fed.Results: Univariate analysis showed that in the aggressive group there was a 66% reduction in the risk of post natal malnutrition at 40 weeks of postmenstrual age (OR 0.34; 95% CI 0.17-0.67). This difference persisted in the multivariate analysis. Energy and protein deficits were lower in the aggressive group (P<0.001).Conclusions: Early and aggressive introduction of total parenteral nutrition and enteral feeding resulted in better growth in weight, length and head circumference, and a reduction of nutritional deficits at 40 weeks of postmenstrual age.

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In the whole population, the early administration of rHuEPO induced a rise of reticulocyte counts, but not enough to reduce the transfusion requirement. The most severely ill infants (BW <800 g and phlebotomy losses >30 mL/kg) seemed to benefit from early use of rHuEPO, and this deserves additional study.

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