Nutritional Practices and Growth Velocity in the First Month of Life in Extremely Premature Infants

Department of Neonatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.
PEDIATRICS (Impact Factor: 5.47). 09/2009; 124(2):649-57. DOI: 10.1542/peds.2008-3258
Source: PubMed


The goals of this study were to describe nutritional practices in the first month of life for a large cohort of extremely low gestational age newborns and to determine the impact of these nutritional practices on growth velocity (GV) over the same period.
The sample included 1187 infants born at 23 to 27 weeks of gestation, at 14 institutions, between 2002 and 2004. Inclusion criteria included survival until day 28 and weight information for days 7 and 28. GV, expressed as grams per kilogram per day, was calculated for the interval between days 7 and 28. Nutritional practices during the first week and on days 14, 21, and 28 were compared with current nutritional guidelines in the literature. Multivariable logistic regression models estimated the contribution of limited nutrition to limited GV.
Protein and fat delivery approximated current nutritional recommendations, whereas carbohydrate and total energy intake delivery did not. Despite this, GV of our study infants exceeded the current guideline of 15 g/kg per day. Nevertheless, we found extrauterine growth restriction (ie, weight for gestational age below the 10th centile) in 75% of the infants at 28 days, compared with only 18% at birth. A GV of 20 to 30 g/kg per day was associated with infants' maintaining or exceeding their birth weight z score, with rates in the upper range for the gestationally youngest infants. Early (day 7) nutritional practices were positively associated with GV measured between days 7 and 28.
The early provision of nutrients is an important determinant of postnatal growth. Extrauterine growth restriction remains high in extremely premature infants even when they achieve a GV rate within current guidelines.

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Available from: Camilia R Martin, Oct 12, 2014
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    • "Recommendations for the optimal nutrient intake of preterm infants exist, (C. Agostoni et al., 2010) however, there is evidence that these targets are not achieved (Embleton, Pang, & Cooke, 2001; Grover, Khashu, Mukherjee, & Kairamkonda, 2008; Martin et al., 2009). "
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    ABSTRACT: Introduction In the context of the continuous quest to improve the care of the neonates especially the critically ill premature, the extended role of pharmacists in the process of parenteral nutrition order writing and effective participation in decision-making especially in the neonatal population is increasingly important. This review aims to present results from literature review of available evidence on the pharmacists’ role in neonatal parenteral nutrition therapy. Material and methods Key medical, clinical, and review databases were searched; relevant articles were retrieved and evaluated. Results and discussion A total of 19 papers out of 7127 searched papers met the criteria for inclusion, discussing the review topic. The main focus of the selected papers was on parenteral nutrition practice as related to the pharmacy practice. The overall quality of studies was mixed. Conclusion Overall, the review presents the up-to-date status of the most recent analysis being undertaken on the topic of pharmacist involvement in the parenteral nutrition order writing practices and more specific in the neonatal population over the period from 1979 – 2013. The overall impression is that the practice of pharmacist writing neonatal parenteral nutrition orders already exists, but still limited if compared with the practice pharmacist writing adult parenteral nutrition orders which is much more established in many countries. There was no single clinical study evaluating this practice, as we were able to retrieve only two surveys, which make it difficult to evaluate the pharmacists’ role in this area. Nevertheless, despite the wide variation in literature types, characteristics and quality, there are consistent patterns across all the reviewed literature that competencies of the pharmacist in this field are well represented, which make it very important to carry out good quality clinical studies in this field. Finally, we are currently conducting a prospective clinical study to evaluate the impact of clinical pharmacist as a neonatal PN prescriber, this impact will be judged through the study outcomes as reducing the metabolic and electrolytes complications and increasing the mean daily weight gain during PN therapy and reducing the average number of days of PN till enteral feeding is achieved.
    Saudi Pharmaceutical Journal 07/2014; 41. DOI:10.1016/j.jsps.2014.06.009 · 1.28 Impact Factor
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    • "That fact might be related to the anatomical and physiological immaturity of the respiratory system,(15) leading to greater chest and upper airway instability that hinder successful extubation.(11) Similarly, although in contrast to the results of the multivariate analysis in the present study, infants with BW<1,000 g exhibit high morbidity rates, which increase their energy expenditure and nutritional requirements, thus impairing the respiratory function, which is nutrition dependent.(16) "
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    ABSTRACT: Objective: To identify risk factors for extubation failure and reintubation in newborn infants subjected to mechanical ventilation and to establish whether ventilation parameters and blood gas analysis behave as predictors of those outcomes. Methods: Prospective study conducted at a neonatal intensive care unit from May to November 2011. A total of 176 infants of both genders subjected to mechanical ventilation were assessed after extubation. Extubation failure was defined as the need to resume mechanical ventilation within less than 72 hours. Reintubation was defined as the need to reintubate the infants any time after the first 72 hours. Results: Based on the univariate analysis, the variables gestational age <28 weeks, birth weight <1,000 g and low Apgar scores were associated with extubation failure and reintubation. Based on the multivariate analysis, the variables length of mechanical ventilation (days), potential of hydrogen (pH) and partial pressure of oxygen (pO₂) remained associated with extubation failure, and the five-minute Apgar score and age at extubation were associated with reintubation. Conclusion: Low five-minute Apgar scores, age at extubation, length of mechanical ventilation, acid-base disorders and hyperoxia exhibited associations with the investigated outcomes of extubation failure and reintubation.
    03/2014; 26(1):51-6. DOI:10.5935/0103-507X.20140008
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    • "Despite current strategies aimed at appropriate nutrition, a large proportion of these infants have postnatal growth failure, also called extrauterine growth restriction (anthropometric values < 10th percentile) [8,10,11]. A cohort study of infants < 28 weeks gestational age showed that growth velocities greater than current guidelines are needed to ensure that infants maintain their birth weight percentile on the growth curve and avoid extrauterine growth restriction [12]. Recommended enteral nutrient intakes per Tsang guidelines [13] for VLBW infants are 110–130 kilocalories per kilogram per day (kcal/kg/d) with 3.4-4.2 "
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    ABSTRACT: Despite current nutritional strategies, premature infants remain at high risk for extrauterine growth restriction. The use of an exclusive human milk-based diet is associated with decreased incidence of necrotizing enterocolitis (NEC), but concerns exist about infants achieving adequate growth. The objective of this study was to evaluate growth velocities and incidence of extrauterine growth restriction in infants <= 1250 grams (g) birth weight (BW) receiving an exclusive human milk-based diet with early and rapid advancement of fortification using a donor human milk derived fortifier. In a single center, prospective observational cohort study, preterm infants weighing <= 1250 g BW were fed an exclusive human milk-based diet until 34 weeks postmenstrual age. Human milk fortification with donor human milk derived fortifier was started at 60 mL/kg/d and advanced to provide 6 to 8 additional kilocalories per ounce (or 0.21 to 0.28 kilocalories per gram). Data for growth were compared to historical growth standards and previous human milk-fed cohorts. We consecutively evaluated 104 infants with mean gestational age of 27.6 +/- 2.0 weeks and BW of 913 +/- 181 g (mean +/- standard deviation). Weight gain was 24.8 +/- 5.4 g/kg/day with length 0.99 +/- 0.23 cm/week and head circumference 0.72 +/- 0.14 cm/week. There were 3 medical NEC cases and 1 surgical NEC case. 22 infants (21%) were small for gestational age at birth. Overall, 45 infants (43%) had extrauterine growth restriction. Weight velocity was affected by day of fortification (p = 0.005) and day of full feeds (p = 0.02). Our cohort had significantly greater growth in weight and length compared to previous entirely human milk-fed cohorts. A feeding protocol for infants <= 1250 g BW providing an exclusive human milk-based diet with early and rapid advancement of fortification leads to growth meeting targeted standards with a low rate of extrauterine growth restriction. Consistent nutritional policies using this approach may be considered for this population.
    BMC Research Notes 11/2013; 6(1):459. DOI:10.1186/1756-0500-6-459
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