Outcome of Very Preterm Infants With Early Optimal Nutrition Strategy: A Comparative Cohort Study

Abstract

Background Aggressive nutrition may benefit early growth; nevertheless, effects on neurodevelopmental outcomes are unclear. We planned a descriptive analytical study to compare survival without neurodevelopment disability (NDD) at 1 year in 2 groups during 2 time epochs—before and after implementation of early optimal nutrition strategies. NDD was defined as any one of the following: mental and/or motor development quotient < 85 at 12 months of age, corrected for prematurity; Denver Developmental Screening Test abnormal/suspect in even 1 domain out of the 4 domains; seizures; requirement of hearing aid; or blindness in 1 or both eyes. We also compared mortality, survival without bronchopulmonary dysplasia, necrotizing enterocolitis (NEC), retinopathy of prematurity (ROP), intraventricular hemorrhage, periventricular leukomalacia, sepsis, metabolic bone disease (MBD), and extrauterine growth restriction (EUGR). Methods Preterm neonates born between 27 and 32 weeks’ gestation were included. The prospective study group (AO) was recruited after implementation of early optimal nutrition policy. The comparative retrospective cohort (BO) received nutrition based on clinicians’ decisions. Both groups were followed up using a structured plan till 1 year corrected age. Results 137 neonates were enrolled in AO and 151 in the BO cohort. There was no statistically significant difference in survival without NDD at 1 year—75.5% in AO vs 72.1% in BO, odds ratio 0.84 (95% CI 0.5–1.6). Babies who received early optimal nutrition had less NEC, EUGR, and ROP requiring laser therapy but more MBD. Conclusion There was no difference in survival without NDD in early optimal nutrition cohort compared to the cohort before implementation of the nutrition strategy. Short‐term benefits themselves may justify the need for early optimal nutrition.

Nutrição enteral precoce em neonatos prematuros e com baixo peso: uma revisão integrativa

“…O presente estudo demonstrou que a maioria dos ar gos atuais defendem o uso de nutrição enteral precoce e de progressão rápida em neonatos prematuros e de baixo peso, contrariando a an ga hipótese de que esse po de terapia poderia trazer male cios para esses bebês (MONTEALEGRE-POMAR et al, 2021;ALSHAIK et al, 2021;UPADHYAY et al, 2020;CORMACK et al, 2019;T'NGCHANG;DORLING;GALE, 2019;ABRANCHES et al, 2018;LYDEN;ANDERSON-BERRY, 2018;SALAS et al, 2018;AMIN, 2016).…”

Basic Life Support Guidance for Caregivers of NICU Graduates: Evaluation of Skill Transfer after Training

“…8 The unit follows a well-known indigenously designed checklist format for high-risk newborn care commencing in the perinatal period itself (Blue book). 9 10 11 Families are prepared for the necessity for BLS training during counseling sessions close to rooming-in. We included parents of neonates (planned for discharge) satisfying any one of the following criteria: (1) birth at gestational age < 32 weeks, (2) neonatal encephalopathy warranting specific therapy, (3) congenital airway anomaly confirmed by video laryngoscopy, and (4) brief, resolved, unexplained event requiring admission and NICU monitoring.…”

Metabolic Bone Disease of Prematurity: Discerning Calcium Versus Phosphorus Deficiency and Role of Calcitriol in Its Management

“…1 The incidence of MBDP amongst preterm neonates born between 27 and 32 weeks gestation in a tertiary neonatal center in India was found to be 30.1% even after implementation of early optimal nutrition policy. 2…”

“…1 The incidence of MBDP amongst preterm neonates born between 27 and 32 weeks gestation in a tertiary neonatal center in India was found to be 30.1% even after implementation of early optimal nutrition policy. 2 As the majority of calcium and phosphorus accretion occur in utero during the 3 rd trimester, babies born before the 3rd trimester are deprived of these important mineral stores compared to their term counterparts. 3 Other factors that can contribute to MBDP are prolonged total parental nutrition (TPN) with delayed fortified enteral feeding, concurrent use of bone active medications, TPN-related cholestasis, and necrotizing up till 3 months of age.…”