Prevention of Postnatal Undernutrition in Very Low Birth Weight Infants Through Early and Aggressive Enteral and Parenteral Nutrition

N. Alejandro Dinerstein, Ricardo M. Nieto, Claudio L. Solana, Gaston P. Perez, Rodolfo J. Raviolo, A. Miguel Larguia.

Neonatology, Htal. Materno Infantil Ramon Sarda, Buenos Aires, Argentina; Fresenius Kabi, Buenos Aires, Argentina.

BACKGROUND:

Nutrient intakes recommended by the American Academy of Pediatrics for very low birth weight infants (VLBW) seem not to be achieved since undernutrition is frequently observed during hospitalization.

OBJECTIVE:

We designed a nutritional intervention to reach recommended energy and protein intakes early after birth with the objective to reduce postnatal growth retardation and to compare energy and protein intakes, deficits and postnatal growth between this group and an historical control group of the immediately preceding year.

DESIGN/METHODS:

Human milk and/or premature formula of 10 ml/kg/day were started on the first day of life, increasing by 10 to 20 ml/kg/day until reaching 180 ml/kg/day. Parenteral amino acids were started at birth at 1,5 g/kg/day with daily increments of 0.5 g/kg until reaching 4 g/kg/day. Lipids were initiated by the second day, starting with 0.5 g/kg/day from a 20% emulsion and increasing by 0.5 g/kg daily to a maximum of 3.5 g/k/d. Parenteral nutrition continued until 80 kcal/kg/day were administered enterally.

RESULTS:

From August 2001 to July 2003 a total of 124 patients were included in the treated group and 72 in the control group. Mean birthweight for the treated group was 1170 g (229) and gestational age 29.9 (2.4) weeks, similar to those of the control group (1200 g 213 and 29.9 2.4). There were no significant differences between groups in morbility and mortality. A lower incidence of undernutrition (weight < 10th percentile ) was observed in the treatment group at 40 weeks compared with the control group (p = .016). There were fewer babies with head circumference (HC)< 3rd percentile at term in the treated group (p=.01). HC gain from birth to 40 weeks was 1 cm greater (p=.04) in the treatment group. Energy and protein intakes during the first 4 postnatal weeks were 373 kcal/kg and 23.4 g/kg higher in the treatment group (p <.001) and the respective deficits were lower (p <.001).

CONCLUSIONS:

This nutritional intervention significantly reduced postnatal undernutrition in VLBW infants but did not completely prevent it. We speculate that postnatal growth retardation might be due to difficulties in avoiding energy and protein deficits and/or because recommended dietary intakes are insufficient for these infants.