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Impact of introducing a standardized nutrition protocol on very premature infants' growth and morbidity.

ABSTRACT: BACKGROUND:Inappropriate nutritional intake in premature infants may be responsible for postnatal growth restriction (PGR) and adverse long-term outcomes. OBJECTIVE:We evaluated the impact of an updated nutrition protocol on very premature infants' longitudinal growth and morbidity, and secondly the compliance to this new protocol. DESIGN:All infants born between 26-32 weeks gestation (GA) were studied retrospectively during two 6-month periods before (group 1) and after (group 2) the introduction of an optimized nutrition protocol, in a longitudinal comparative analysis. RESULTS:158 infants were included; 72 before and 86 after the introduction of the protocol (Group 1: (mean±SD) birthweight (BW) 1154±276 g, GA 29.0±1.4 weeks; Group 2: BW 1215±332 g, GA 28.9±1.7 weeks). We observed growth improvement in Group 2 more pronounced in males (weight z-score) at D42 (-1.688±0.758 vs. -1.370±0.762, p = 0.045), D49 (-1.696±0.776 vs. -1.370±0.718, p = 0.051), D56 (-1.748±0.855 vs. -1.392±0.737, p = 0.072), D63 (-1.885±0.832 vs. -1.336±0.779 p = 0.016), and D70 (-2.001±0.747 vs. -1.228±0.765 p = 0.004). There was no difference in females or in morbidities between the groups. We observed low compliance to the protocol in both groups: similar energy intake but higher lipid intake in Group 1 and higher protein intake in Group 2. CONCLUSION:The quality of nutritional care with a strictly-defined protocol may significantly improve weight gain for very preterm infants. As compliance remained low, an educational reinforcement is needed to prevent PGR. CLINICAL TRIAL REGISTRATION:This retrospective study was registered by ClinicalTrials.gov under number NCT03217045, and by the CNIL (Commission Nationale de l'Informatique et des Libertés) under study number R2015-1 for the Maternity of the CHRU of Nancy.

SUBMITTER: Wittwer A

PROVIDER: S-EPMC7241817 | biostudies-literature | 2020

REPOSITORIES: biostudies-literature

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Impact of introducing a standardized nutrition protocol on very premature infants' growth and morbidity.

Wittwer Apolline A Hascoët Jean-Michel JM

PloS one 20200521 5

<h4>Background</h4>Inappropriate nutritional intake in premature infants may be responsible for postnatal growth restriction (PGR) and adverse long-term outcomes.<h4>Objective</h4>We evaluated the impact of an updated nutrition protocol on very premature infants' longitudinal growth and morbidity, and secondly the compliance to this new protocol.<h4>Design</h4>All infants born between 26-32 weeks gestation (GA) were studied retrospectively during two 6-month periods before (group 1) and after (g ...[more]

PMID: 32437423

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Project description:BACKGROUND:Parenteral nutrition associated cholestasis (PNAC) is a frequently observed pathology in extremely low birth weight (ELBW) infants. Its pathogenesis is determined by the composition and duration of parenteral nutrition (PN) as well as the tolerance of enteral feeds (EF). "Aggressive" nutrition is increasingly used in ELBW infants to improve postnatal growth. Little is known about the effect of "aggressive" nutrition on the incidence of PNAC. We analyzed the influence of implementing an "aggressive" nutritional regimen on the incidence of PNAC and growth in a cohort of ELBW infants. METHODS:ELBW infants were nourished using a "conservative" (2005-6; n = 77) or "aggressive" (2007-9; n = 85) nutritional regimen that differed in the composition of PN after birth as well as the composition and timing of advancement of EFs. We analyzed the incidence of PNAC (conjugated bilirubin > 1.5 mg/dl (25 µmol/l)) corrected for confounders of cholestasis (i.e., NEC and/or gastrointestinal surgery, sepsis, birth weight, Z-score of birth weight, time on PN and male sex), growth until discharge (as the most important secondary outcome) and neonatal morbidities. RESULTS:The incidence of PNAC was significantly lower during the period of "aggressive" vs. "conservative "nutrition (27% vs. 46%, P < 0.05; adjusted OR 0.275 [0.116-0.651], P < 0.01). Body weight (+411g), head circumference (+1 cm) and length (+1 cm) at discharge were significantly higher. Extra-uterine growth failure (defined as a Z-score difference from birth to discharge lower than -1) was significantly reduced for body weight (85% vs. 35%), head circumference (77% vs. 45%) and length (85% vs. 65%) (P < 0.05). The body mass index (BMI) at discharge was significantly higher (11.1 vs. 12.4) using "aggressive" nutrition and growth became more proportionate with significantly less infants being discharged below the 10th BMI percentile (44% vs. 9%), while the percentage of infants discharged over the 90th BMI percentile (3% vs. 5%) did not significantly increase. DISCUSSION:"Aggressive" nutrition of ELBW infants was associated with a significant decrease of PNAC and marked improvement of postnatal growth.

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Impact of introducing a standardized nutrition protocol on very premature infants' growth and morbidity.

Publications

Impact of introducing a standardized nutrition protocol on very premature infants' growth and morbidity.

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