A nutritional program to improve outcome of very low birth weight infants

Abstract

The growth of very low birth weight infants does not match intrauterine trajectories, likely due to inappropriate caloric intake. We therefore investigated whether modification of the standard nutritional schedule can impact postnatal growth. We introduced a set of evidence-based strategies in a study group of infants (n=123): 1)higher maximum intake of intravenous amino acids and lipids; 2) prioritisation of earlier enteral feeding; 3) faster attainment of full enteral feeds; 4) daily adjustment of enteral feeds according to growth trajectory; and 5) utilisation of an electronic pre-structured prescription ordering system that tracks individual growth and energy intake. These infants were compared with a control group (n=115) in a pre/post retrospective cohort study. The study group achieved a higher caloric intake, attained full enteral feeds 5 days earlier, and returned to their birth weight more rapidly than the control group. At 36 weeks postmenstrual age, infants who had been born at <30 weeks were heavier (Δ260g) but had a similar percentage fat mass. Those born at <28 weeks had a larger head circumference (Δ1.4cm) and lower sepsis rate (7.8%). Optimization of early postnatal nutrition and daily adjustment of milk intake according to weight gain improved growth, without any unfavourable outcomes for body composition and neurodevelopmental follow-up.