Nutritional therapies in the neonatal intensive care unit and post‐natal growth outcomes of preterm very low birthweight Asian infants

Abstract

Aim A collaborative study was conducted between two Southeast Asian university hospitals to compare the nutritional intervention and growth outcomes and evaluate the extent of post‐natal growth faltering (PNGF) among very low birthweight (VLBW) infants. Methods Data of all infants admitted during the 2011–2012 period to the two hospitals at Singapore (SG) and Malaysia (MY) were pooled and analysed. Results Of the 236 infants, SG infants received lower total protein and energy intake than MY infants (2.69 vs. 3.54 g/kg/day and 92.4 vs. 128.9 kcal/kg/day respectively; P < 0.001) in enteral feeds, with Singaporean infants predominantly fed fortified breast milk than Malaysian infants (45/48 vs. 10/41; P < 0.01). The mean weight z‐score from birth to 36 weeks corrected age was significantly different (SG,−2.2 (0.9) vs. MY, −1.4 (0.7); P = 0.001). More SG than MY extremely low birthweight (ELBW) infants had severe PNGF >−2 SDS (55 vs. 16%; P = 0.001). The greater use of a diuretic in SG to treat haemodynamically significant patent ductus arteriosus (hsPDA) may have contributed to the higher PNGF rate. Mean growth velocity of at least 15 g/kg/day was attained by VLBW infants only from Day 14 and by ELBW infants only from Day 28 post‐natally. Overall, severe PNGF rates (z‐score change >−2 SDS at 36 weeks' corrected age) were 28.8 and 36.5% for VLBW and ELBW infants, respectively. Conclusions Being very preterm, ELBW with hsPDA and receiving insufficient protein and energy were risk factors for severe PNGF. Increasing protein and energy content, augmenting fortification of breast milk and concentrating feed volumes, especially if there is an hsPDA, may curb severe PNGF among these infants.

A Systematic Review and Meta-Analysis of Human Milk Feeding and Short-Term Growth in Preterm and Very Low Birth Weight Infants

“…Forty-four papers were identified for this review and included nine RCTs [ 15 , 19 , 20 , 21 , 31 , 32 , 33 , 34 , 35 ], one non-randomised intervention trial [ 36 ], three secondary analyses of RCTs [ 9 , 37 , 38 ], six interrupted time series studies [ 8 , 28 , 39 , 40 , 41 , 42 ], and 25 cohort studies [ 7 , 22 , 29 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 ]. Thirty-seven studies could be included in the meta-analyses [ 7 , 8 , 9 , 15 , 19 , 20 , 21 , 22 , 28 ,…”

“…Of the non-randomised and observational studies, 28 were assessed as low risk of bias [ 7 , 8 , 9 , 15 , 19 , 20 , 21 , 22 , 35 , 38 , 39 , 40 , 41 , 42 , 43 , 45 , 47 , 49 , 50 , 52 , 55 , 57 , 58 , 59 , 60 , 61 , 63 , 64 ], 11 as moderate [ 28 , 29 , 36 , 37 , 44 , 46 , 48 , 51 , 54 , 56 , 62 ], and 1 as high [ 53 ] ( Table 1 ).…”

“…Weight gain was reported in 41 studies [ 7 , 8 , 9 , 19 , 20 , 21 , 22 , 28 , 29 , 31 , 32 , 33 , 34 , 35 , 36 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 ]. Twenty-four studies reported g/kg/d, with 20 included in the meta-analysis [ 9 , 19 , 20 , 21 , 28 , 29 , 33 , 34 , 35 , 39 , 40 , 47 , ...…”

“…Four studies reported weight gain in g/d [ 31 , 36 , 48 , 53 ], with three included in the meta-analysis [ 31 , 36 , 48 ]. Nineteen studies reported weight gain as change in z-scores with 14 included in meta-analyses [ 7 , 8 , 22 , 28 , 32 , 42 , 44 , 47 , 49 , 50 , 51 , 55 , 61 , 63 ] and five not included [ 38 , 41 , 43 , 46 , 62 ].…”

“…Seventeen studies reported weight gain as change in z-scores during the hospital admission, and 12 of these were included in the meta-analysis [ 7 , 8 , 22 , 28 , 42 , 44 , 47 , 49 , 50 , 51 , 61 , 63 ]. Infants fed lower-dose HM had a greater increase in z-score change than those fed higher-dose HM (MD 0.19, 95% CI 0.06 to 0.33, n = 4059, I 2 = 78%, Figure 3 , very low certainty evidence, Table S4 ).…”