Length of Nutritional Transition Associates Negatively with Postnatal Growth in Very Low Birthweight Infants

Lotta Immeli,Pauliina M Mäkelä,Reijo Sund,Sture Andersson,Ulla Sankilampi,Päivi Luukkainen,Markus Leskinen

doi:10.3390/nu13113961

Abstract

Very low birthweight (VLBW, <1500 g) infants may be predisposed to undernutrition during the nutritional transition phase from parenteral to enteral nutrition. We studied the associations among the length of the transition phase, postnatal macronutrient intake, and growth from birth to term equivalent age in VLBW infants. This retrospective cohort study included 248 VLBW infants born before 32 weeks of gestation and admitted to the Children’s Hospital, Helsinki, Finland during 2005–2013. Daily nutrient intakes were obtained from computerized medication administration records. The length of the transition phase correlated negatively with cumulative energy, protein, fat, and carbohydrate intake at 28 days of age. It also associated negatively with weight and head circumference growth from birth to term equivalent age. For infants with a long transition phase (over 12 d), the estimates (95% CI) for weight and head circumference z-score change from birth to term equivalent age were −0.3 (−0.56, −0.04) and −0.44 (−0.81, −0.07), respectively, in comparison to those with a short transition phase (ad 7 d). For VLBW infants, rapid transition to full enteral feeding might be beneficial. However, if enteral nutrition cannot be advanced, well-planned parenteral nutrition during the transition phase is necessary to promote adequate growth.

Highlights

A very preterm birth may be regarded as a nutritional emergency, and very low birthweight infants (VLBW, birthweight below 1500 g) need parenteral nutrition (PN) during the first days or weeks of life
Extrauterine growth retardation is common in VLBW infants and suboptimal nutrition and growth have been associated with adverse short- and long-term outcomes [4,5,6,7]
We aimed to study how the length of the transition phase from parenteral to enteral nutrition associates with macronutrient intake and postnatal growth in VLBW infants

Summary

Introduction

A very preterm birth may be regarded as a nutritional emergency, and very low birthweight infants (VLBW, birthweight below 1500 g) need parenteral nutrition (PN) during the first days or weeks of life. Enteral nutrition (EN) with small volumes of milk is started and increased gradually according to tolerance. Nutritional guidelines for both parenteral and enteral intake in preterm infants have been published [1,2,3]. Guidelines or consensus on how to optimize nutritional care during the transition phase is missing, and practices vary across centers. Data on how this transition phase in VLBW infants affects nutritional intake and postnatal growth remain scarce. For example, how the length of the transition phase affects macronutrient intake and postnatal growth

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