A nutritional program to improve outcome of very low birth weight infants

Rochow, Niels; Fusch, Gerhard; Mühlinghaus, Alexandra; Niesytto, C.; Straube, Sebastian; Utzig, N; Fusch, Christoph

doi:10.1016/j.clnu.2011.07.004

Cited by 71 publications

(80 citation statements)

References 28 publications

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“…In contrast to our findings, most published studies report that postnatal growth trajectories of preterm infants increasingly divert from intrauterine reference curves (6,7,10,23). This discrepancy is caused by several factors.…”

contrasting

confidence: 56%

“…The impact seems to be center-specific (1,6,(17)(18)(19)(20). Preterm infants with undisturbed postnatal adaptation who are not exposed to growth-affecting conditions may represent the most appropriate model to study physiological postnatal weight loss and early weight gain in order to determine which postnatal growth trajectory preterm infants best adapt to.…”

Section: Preterm Infant Growth Trajectoriesmentioning

confidence: 99%

“…Delayed nutritional support, slow postnatal enteral feeding advancement, prolonged use of parenteral nutrition, repeated bouts of feeding intolerance, and/or providing nutrition that does not provide the optimal composition and nutrients needed for Articles high growth rates in preterm infants can aggravate this deficit. The impact seems to be center-specific (1,6,(17)(18)(19)(20).…”

mentioning

confidence: 99%

“…Most published postnatal growth patterns for preterm infants were established by studying neonatal intensive care unit (NICU) cohorts, which inevitably consist of a mix of sick and more healthy infants (6)(7)(8)(9)(10). The resulting growth pattern will therefore not reflect the true potential of postnatal growth for healthy preterm infants.…”

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confidence: 99%

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Physiological adjustment to postnatal growth trajectories in healthy preterm infants

et al. 2016

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Background: International guidelines suggest that growth of preterm infants should match intrauterine rates. However, the trajectory for extrauterine growth may deviate from the birth percentile due to an irreversible, physiological loss of extracellular fluid during postnatal adaptation to extrauterine conditions. To which "new" physiological growth trajectory preterm infants should adjust to after completed postnatal adaptation is unknown. This study analyzes the postnatal growth trajectories of healthy preterm infants using prospective criteria defining minimal support, as a model for physiological adaptation. Methods: International, multi-center, longitudinal, observational study at five neonatal intensive care units (NICUs). Daily weights until day of life (DoL) 21 of infants with undisturbed postnatal adaptation were analyzed (gestational ages: (i) 25-29 wk, (ii) 30-34 wk). results: 981 out of 3,703 admitted infants included. Maximum weight loss was 11% (i) and 7% (ii) by DoL 5, birth weight regained by DoL 15 (i) and 13 (ii). Infants transitioned to growth trajectories parallel to Fenton chart percentiles, 0.8 z-scores below their birth percentiles. The new trajectory after completed postnatal adaptation could be predicted for DoL 21 with R 2 = 0.96. conclusion: This study provides a robust estimate for physiological growth trajectories of infants after undisturbed postnatal adaptation. In the future, the concept of a target postnatal trajectory during NICU care may be useful. i mproved survival rates of very-low-birth-weight (<1,500 g birth weight) infants have shifted the focus of neonatal care onto improving postnatal growth and nutrition, aiming to achieve growth rates that optimize later health outcomes (1). Pediatric societies in North America and Europe have recommended that postnatal growth of preterm infants match the in utero growth rates of fetuses that remain in utero until full-term (2-4). These recommendations gain importance in light of the Developmental Origins of Health and Disease (DOHaD) hypothesis (5). The DOHaD concept suggests that suboptimal growth of a fetus or a newborn infant can impact the early onset of adult metabolic and cardiovascular diseases. In utero, the growth rate of an individual fetus is determined by its genetic potential and modified by "environmental" factors such as maternal nutrition, body composition, pathologies, or altitude above sea level. After birth, growth patterns of preterm infants are under external control by neonatal staff who modify the infants' nutrient intake. Figure 1 shows three hypothetical postnatal trajectories for a given preterm infant (27 wk of gestation, birth weight 1,000 g). It is of interest to note that these trajectories have similar slopes and hence not dramatically different growth rates. However, postnatal adjustment to different percentiles during the phase of stable growth will lead to different body compositions-potentially affecting later health outcomes.The current evidence for optimal postnatal growth trajectories is scarce....

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contrasting

confidence: 56%

Section: Preterm Infant Growth Trajectoriesmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Physiological adjustment to postnatal growth trajectories in healthy preterm infants

et al. 2016

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“…According to specific nutritional protocols (Tables 1 and 2), 19 enteral feeding must gradually increase. 20 Usually, the progression is from 15-30 mL/kg/up to enteral doses of 150-170 mL/kg/day. Breast milk is used as first choice and, when not available, human donors milk banks or premature formulas are the alternatives.…”

Section: Enteral Nutritionmentioning

confidence: 99%

Feeding of preterm infants and fortification of breast milk

Mangili

Garzoli

2017

Pediatr Med Chir

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The administration of the adequate amount of nutrients helps to improve a correct short-term linear growth and long-term neurocognitive development. To reduce the extra-uterine growth delay in very low birth weight infants (VLBW) the best strategy of nutrition (parenteral or enteral) should be established rapidly, since the first day of life. In preterm infants, nutrition can be administered parenterally and enterally. Prematurity is the most frequent indication for parenteral nutritional support due to intestinal functional immune deficiency, deficiency of digestive enzymatic systems and reduced nutritional reserve of these infants. In terms of enteral nutrition, breast milk is the first choice. In case of preterm and VLBW infants, fortifiers are used to overcome breast milk's protein and mineral deficiencies. When breast milk is not available, specific infant formula is the alternative. IntroductionThe improvement of neonatal care has led to an increase in the survival rate of very low birth weight infants (VLBW) infants (<1500 g). Nonetheless, growth failure is still a very frequent issue with incidence that ranges from 43 to 97% among various neonatal units. Thus, more aggressive nutritional strategies have been developed: first the parenteral nutrition then the enteral nutrition. Parenteral nutrition is often the only source of nutrients that can be used during the period of clinical instability. 1 Enteral nutrition must be gradually introduced as soon as possible; in presence of a good enteral tolerance, the parenteral nutrition should be rapidly discontinued, thus reducing its related side effects. 2 Parenteral nutritionAssuring an adequate nutrition to preterm infants is a real challenge, especially during the first hours after birth, when a total parenteral nutrition (TPN) is needed to meet the high nutritional requirements but it is often complicated by glucose and lipids intolerance. 3 Parenteral nutrition (PN) is an intravenous nutritional therapy that includes the administration of fluids, electrolytes, glucose, proteins, lipids, minerals, vitamins and oligo-elements. 4 It should be started as soon as possible within the first 24 hours of life. It can be prescribed in individualized or standardized administration; PN is provided through a central catheter (umbilical vein catheter or percutaneous central catheter) or, temporarily, via a peripheral route in the case of partial parenteral solutions and low osmolar load (<600 mOsm/L). Fluids and electrolytesIn the first week of life changes occur in the extracellular and intracellular compartments, resulting in a redistribution of fluids. This is one of the reason that explains the weight loss (5-10% of birth weight) that usually takes place during the first days of life. The fluid intake in the newborn (VLBW) and very low birth weight (ELBW) starts with 80-90 mL/kg/day and then is gradually increased by 10-20 mL/kg/day up to 160-180 and 150-160 mL/kg/day, respectively. 2,5-8 Electrolytic supplementation usually begins on the third-fourth day of...

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Individualized Postnatal Growth Trajectories for Preterm Infants

Landau-Crangle

Rochow

Fenton

et al. 2018

J Parenter Enteral Nutr

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GVA provides an evidence-based approach for individualized growth trajectories. GVA is based on physiologic data and that healthy preterm infants adjust their postnatal trajectory below their birth percentile. GVA may reflect a biologic principle because it matches consistently with WHOGS at 42+0/7 weeks for all preterm infants from 24 to 34 weeks. This concept could become a bedside tool to aid clinicians in monitoring growth, guiding nutrition, and minimizing chronic adult disease risks as a consequence of unguided, inappropriate growth.

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A nutritional program to improve outcome of very low birth weight infants

Cited by 71 publications

References 28 publications

Physiological adjustment to postnatal growth trajectories in healthy preterm infants

Physiological adjustment to postnatal growth trajectories in healthy preterm infants

Feeding of preterm infants and fortification of breast milk

Individualized Postnatal Growth Trajectories for Preterm Infants

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