Beca de Investigación “Ramón Carrillo – Arturo Oñativia” a Nivel Hospitalario. Concurso 2002
Lugar de Realización: Servicio de Neonatología – Hospital Materno Infantil “Ramón Sardá” – Ciudad Autónoma de Buenos Aires – República Argentina
Becario: Dr. Néstor Alejandro Dinerstein
Director del proyecto: Dr. A. Miguel Larguía.
Abstract:
Background:
Postnatal growth retardation is frequently observed in premature newborns with birth weight less than 1500 gs (VLBW). Recent data from NICHD indicate that 16% of them are IUGR ( intrauterine growth retarded ) and this proportion increases up to 89% at 36 weeks of postconceptional age. Low nutrients intakes during the neonatal period are major contributives to growth ratardation.
Recommended energy intakes from Nutrition Committee of American Academy of Pediatrics (AAP) for VLBW infants are: 120 Kcal./kg/day for enteral route and 80 to 100 Kcal/kg/day for parenteral route; protein intakes suggested are 3 to 4 g/kg/day. Nevertheless, this recommendations seems not to be enough to prevent undernutrition observed in VLBW during hospitalization in neonatal intensive care units. We designed an aggresive nutritional intervention to reach this energy and protein intakes early after birth and to maintain them throughout the first four weeks of life to reduce postnatal growth retardation
Objectives:
- To implement an early and aggressive enteral and parenteral nutritional protocol designed to accomplish with the AAP recommendations for reducing postnatal undernutrition.
- To compare energy and protein intakes, deficits and postnatal growth between this group and an recent historical control group, similar in clinical and demographics characteristics, born and assisted in the immediate previous year.
Intervention:
Enteral intakes of human milk and/or premature formula of 10 ml/Kg/day since the first day of life, increasing progressively by 10 to 20 ml/kg/day until reaching 180 ml/Kg/day , plus parenteral administration of amino acids since birth, initiating with 1,5 g/Kg/day and increments of 0.5 g/Kg daily, until reaching 4 g/Kg/day. Lipids were initiated by the second day , starting with 0.5 g/Kg/day of a 20% solution and increasing 0,5 g/Kg daily until a maximum of 3,5 g/k/d , depending on plasma triglycerides level. Parenteral nutrition continued until 80 Kcal/Kg/day were enterally administered.
Results:
Lower incidence of undernutrition (weight < 10th. percentile ) was observed in patients of the treated group at 40 postconceptional weeks of age compared with control historical group (p = .016). There were less babies with head circumference < 3rd percentile at 40 weeks in the treated group (p=.01). Head circumference increment, in centimeters, from birth to 40 weeks was 1 cm higher in treated group ( p=.04). Energy and protein intakes during the first 4 postnatal weeks were 373 Kcal/Kg and 23.4 g/Kg higher in the treated group ( P <.001) and for instance lower their deficits (P <.001).
Conclussion:
The implementation of this nutritional intervention significantly reduced postnatal undernutrition in VLBW but did not avoided it. We speculate that postnatal growth retardation might be due to difficulties in avoiding energy and protein deficits and/or that recommended dietary intakes are insufficient for this infants.
