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

Abstract

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.

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

“…Different NICUs have different nutrition support practices . In our study, the average maximum doses of protein intake in EUGR and non‐EUGR groups were 3.15 ± 0.48 and 2.98 ± 0.42 g/kg/d, respectively, and were lower than the recommended levels (3.5–4.0 g/kg/d).…”

“…It is important to provide stable and adequate nutrients not only in the first weeks of life, but throughout the hospital, and even when discharged home. The implementation of a program with potential improvement of nutrition practices may promote a more adequate supply of nutrients, reduce EUGR, and decrease comorbidities in VLBWIs …”

Diagnosing Pediatric Malnutrition

“…Research that evaluates the growth of premature infants uses the concept of “delta z score” to capture a decline or deceleration in WAz 77 , 78 . For example, a delta z score of 0 (or within a small range of 0) could reflect normal growth along or near a growth trajectory; a positive delta z score would reflect accelerated growth; and a negative delta z score would reflect a deceleration in growth.…”

Catch-Up Growth in Former Preterm Neonates: No Time to Waste

“…Unfortunately, we still fail to implement these strategies sufficiently, as recently highlighted in a French survey [9]. Using a questionnaire on 276 preterm (30–33 weeks gestational age) neonates hospitalized in 29 different NICUs, the authors documented that there was divergence between the intended and the actual practice for both protein and lipid intake.…”

“…The authors concluded that nutritional support was not in compliance with recommendations and that the rate of EUGR remained relevant. Efforts are needed to improve adherence to nutrition guidelines and growth outcomes: implementation remains a major hurdle [9]: no time to waste . …”