Analysis of Nutrition Support in Very Low‐Birth‐Weight Infants With Extrauterine Growth Restriction

Abstract

Objective: To assess the incidence of extrauterine growth restriction (EUGR) in very low-birth-weight infants (VLBWIs) and evaluate the nutrition factors in VLBWIs associated with inadequate nutrient intakes during hospitalization. Methods: A total of 128 VLBWIs were divided into an EUGR group (n = 87) and a non-EUGR group (n = 41). Growth and parenteral nutrition (PN) and enteral nutrition (EN) practices were analyzed. Actual energy and protein intakes were subtracted from recommended energy (120 kcal/kg/d) and protein (3.75 g/kg/d) intakes, and nutrition deficits were calculated. Results: Growth restriction was 21.9% at birth and 68.0% at discharge. Compared with established guidelines, PN was started late, and the maximum amino acid intake was low in both groups. EN interruption rate was higher in the EUGR group. The average energy intake in the first day after PN termination was lower in the EUGR group. There were significant differences in actual energy and protein intakes in the 2 groups for several weeks during hospitalization. The cumulative energy and protein deficits were significantly higher in the first 8 weeks and during the third to seventh weeks in the EUGR group, respectively.Step regression analysis showed that there was a significant negative correlation between the cumulative deficit of energy and changes of weight z-scores (r = −0.001, P < .05): as the energy deficit loss increased by 100 kcal, the weight z-scores dropped by 0.1 SD. Conclusion: Inadequate nutrition intake aggravated the occurrence of EUGR in VLBWIs, especially the energy intake. (Nutr Clin Pract. 2019;34:436-443)

Reply: “It is Time for a Universal Nutrition Policy in Very Preterm Neonates during the Neonatal Period? Comment on: Applying Methods for Postnatal Growth Assessment in the Clinical Setting: Evaluation in a Longitudinal Cohort of Very Preterm Infants Nutrients 2019, 11, 2772”

“…Even though improvement of postnatal growth and identification of risk factors was one of our aims, the major focus of our paper was to reflect on how different approaches to analyzing postnatal growth can result into confusing and even inaccurate conclusions. Current reported percentages of EUGR are indeed heterogeneous, and range from around the figure in their referenced paper of 25% [2][3][4][5] to others more in line with our prevalence of 40-60% [6][7][8]. Nevertheless, and this was one of the points we were trying to highlight, interpretation must be cautious, because the definitions of EUGR are different, or applied at different time points, or over populations with different prevalence of IUGR or different gestational ages.…”

Correlation between the growth and development of extremely preterm infants in intensive care units and the intestinal microecology

“…Therefore, preterm infants at the NICU have particular intestinal bacterial colonization model, species types and diversity. It is very easy to develop feeding intolerance and growth retardation in such conditions [11].…”

<p>Clinical and Nutritional Determinants of Extrauterine Growth Restriction Among Very Low Birth Weight Infants</p>

“…4 Factors that limit the nutritional and caloric intake include the necessity of fluid restriction, the lack of routinely used central venous access (such as umbilical catheters) beyond the first week of life, the lack or shortage of proper total parenteral nutrition (TPN) service, the limit in the allowed glucose infusion rate and parenteral protein administration based on glycemic control and renal function, and the commonly encountered feeding intolerance resulting in frequent interruptions of enteral feeding. 5 On the other hand, the increased work of breathing and issues related to thermal regulation and processing of enteral feeds increase energy expenditure and contribute to the negative energy balance. Furthermore, prolonged assisted ventilation and the use of methylxanthines and diuretics, among other iatrogenic interventions, contribute to the nutritional deficits.…”

“…7 More recently, a longitudinal definition, based on ˃1 standard deviation reduction in weight z score between birth and discharge, has been more frequently used. 5 The wide variation in the rate of EUGR is related to the heterogeneity of the inclusion criteria and the used definition in different reports. In the USA, the California Perinatal Health Cooperation Organization reported a EUGR rate of 50% in the period 2005-2012.…”