BACKGROUND:

CNS indemnity, which is the result of intrinsic (genetic and hormonal) and extrinsic factors (nutrition, environment, social and emotional status), is indirectly measured by neurodevelopment assessment.

OBJECTIVE:

To evaluate growth, in comparison with a historical control group, at 40 weeks of corrected gestational age (cGA) and psychomotor development (PD) at one year of cGA in VLBW after nutritional intervention.

DESIGN/METHODS:

Clinical trial with a historical control group. Population: inborn infants <32 weeks of gestational age and birth weight ≥750 and ≤1.500 g. Methods: in the treated group (TG) enteral and parenteral nutrition were started on the first day of life. The control group (CG) was fed in accordance with the opinion of the attending physician, resulting in a higher cumulative energy and protein deficit at the end of the fourth week of life (794 Kcal in CG vs 353 in TG and 34 g vs 11 respectively, p<.001). Main endpoints: undernutrition (body weight <10th percentile at 40 cGA weeks), and PD through Rodriguez and col. scale. PD was analyzed using a multivariate model that included as covariates: prenatal steroids, small for gestational age, grouped neonatal morbidity, and maternal education level.

RESULTS:

101 patients completed the evaluation at one year of cGA, 65 in the TG and 36 in the CG. Birth weight (1150 vs. 1190 g), gestational age (30 vs. 29 weeks), head circumference (HC) (25.9 vs 26.5 cm), small for dates (8% vs. 3%), and exposure to prenatal steroids (63% vs.75% ) were similar in both groups. No difference was found in postnatal morbidity or in social, economic, or cultural status. Undernutrition at 40 weeks of cGA was lower in the TG (38% vs. 72%, p=.002). HC was larger in the TG (35.4 vs. 34.6 cm, p=.028). Univariate analyses showed PD was 0.13 higher in the TG (1.02 vs. 0.89, 95% CI: 0.049-0.224). This effect persisted in multivariate analyses, with PD increasing by 0.094 (95% CI: 0.012-0.175) in the TG. Maternal education was a significant variable for improving the PD by 0.014 (95% CI: 0.0003-0.0283).

CONCLUSIONS:

In this population, patients who received early and intensive nutritional intervention had a lower frequency of postnatal undernourishment at 40 weeks cGA and better PD at one year of life.