Nieto RM, Perez GP, Dinerstein NA, Solana CL, Larguía M.
Maternidad Sarda, Buenos Aires, Argentina.

Background:

Nutrient intakes recommended by the AAP for very low birth infants (VLBW) seems not to be achieved since energy and protein deficits are observed during hospitalization according to our own data

Objective:

To reduce postnatal undernutrition providing a nutritional intervention in order to avoid deficits in energy and protein intakes early after birth or compensate them before the 36 weeks of corrected gestational age (cGA) .

Design/Methods:

Newborns infants < 31 weeks of GA and adequate for dates, were randomized to the standard group (SG) who received the recommendations of the AAP for energy and caloric intakes or an intensive intervention (IG), overpassing the usual guidelines, avoiding or compensating nutritional deficits. In the IG, enteral feeding were started on the first day, increasing by 10 to 20 ml/kg/day until reaching 200 ml/kg/day of fortified human milk or prematures formula (24 Kcal/oz). Parenteral amino acids were started at birth at 1,5 g/kg/day with increments of 1 g/kg until reaching 4.5 g/kg/day. Lipids were started by the second day, with 1 g/kg/day and increasing by 1 g/kg to a maximum of 3.5 g/k/d. Parenteral nutrition continued until 100 kcal/kg/day were administered enterally.

Results:

From 7/2004 to 6/2005, 60 patients were born and 50 who survived up to the 36 weeks of cGA were evaluated, 28 in the IG and 22 in the SG. Mean birth weight (BW) for the IG was 1098 g (265) and a GA of 28.2 (1.6) weeks, similar to those of the SG (BW: 1127 g (255) and GA: 28.1 1.4). There were no differences between groups in morbidity, except for PDA , 62.5% in IG and 40% in SG (p:0.001). Undernutrition (weight < 10th percentile ) was similar in both groups (57.1% vs 63.6%) at 36 weeks cGA. Despite the difference in nutritional protocols, energy and protein intakes at 36 weeks postmenstrual age were not different, with zero deficit in 37% in energy and 29% in protein in the SG vs. 26% and 41% in the IG group.

Conclusions:

An intensive nutritional intervention avoiding nutritional deficits did not eliminate postnatal undernutrition, although in both groups was lower than our historical rates. We speculate that the improvement in nutritional care of the standard group was the main reason for the lack of differences in energy and protein intakes during the study period.