Gestational Age-Related Associations between Early-Life Feeding Trajectories and Growth Outcomes at Term Equivalent Age in Very Preterm Infants.

Yung-Chieh Lin,Chi-Hsiang Chu,Yen-Ju Chen,Chao-Ching Huang,Ray-Bing Chen

doi:10.3390/nu14051032

Abstract

Establishing the different feeding trajectories based on daily enteral feeding data in preterm infants at different gestational ages (GAs), may help to identify the risks and extrauterine growth restriction (EUGR) outcomes associated with the adverse feeding pattern. In a single center, we retrospectively included 625 infants born at 23–30 weeks of gestation who survived to term-equivalent age (TEA) from 2009 to 2020. The infants were designated into three GA groups: 23–26, 27–28, and 29–30 weeks. The daily enteral feeding amounts in the first 56 postnatal days were analyzed to determine the feeding trajectories. The primary outcomes were EUGR in body weight and head circumference calculated, respectively, by the changes between birth and TEA. Clustering analysis identified two feeding trajectories, namely the improving and adverse patterns in each GA group. The adverse feeding pattern that occurred in 49%, 20%, and 17% of GA 23–26, 27–28, and 29–30 weeks, respectively, was differentiated from the improving feeding pattern as early as day 7 in infants at GA 23–26 and 27–28 weeks, in contrast to day 21 in infants at GA 29–30 weeks. The adverse feeding patterns were associated with sepsis, respiratory, and gastrointestinal morbidities at GA 23–26 weeks; sepsis, hemodynamic and gastrointestinal morbidities at GA 27–28 weeks; and preeclampsia, respiratory, and gastrointestinal morbidities at GA 29–30 weeks. Using the improving feeding group as a reference, the adverse feeding group showed significantly higher adjusted odds ratios of EUGR in body weight and head circumference in infants at GA 23–26 and 27–28 weeks. Identifying the early-life adverse feeding trajectories may help recognize the related EUGR outcomes of preterm infants in a GA-related manner.

Highlights

The adverse feeding pattern could be distinguished from the improving pattern as early as postnatal day 7 in the two extremely preterm gestational ages (GAs) groups, but as late as day 21 in the very preterm group, which was significantly related to the shared and distinct respiratory/hemodynamic and GI morbidities that occurred in each preterm group
The smaller the GA group, the larger the impact of the adverse feeding pattern on extrauterine growth restriction (EUGR) outcomes in body weight and head circumference. These findings suggested that establishing feeding trajectories in different GA preterm groups could early identify infants at risk of worse growth outcome in body weight and head circumference at term-equivalent age (TEA), in extremely preterm infants
We found that the GI morbidities related to the adverse feeding trajectory were mainly non-necrotizing enterocolitis (NEC) complications requiring surgery for infants at GA

Summary

Introduction

The advances in medical care in the neonatal intensive care unit (NICU) has resulted in an increasing survival rate of extremely preterm infants. Studies have demonstrated the importance of adequate feeding, nutrition and growth, especially in this preterm population [1,2]. Early-life feeding problems may be associated with adverse growth and neurodevelopmental outcomes [1–3]. Nutritional support through enteral feeding for postnatal growth in extremely preterm infants remains a challenge in clinical practice [4,5]

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