Abstract
BackgroundThe nutritional care provided to moderately premature babies is poorly studied. For a large cohort of such babies, we aimed to describe: nutrition practice intentions, comparison of the intended with the actual practice, compliance of actual practice to current nutrition guidelines, and postnatal growth.MethodsA questionnaire was sent out to 29 neonatal intensive care units in France, in order to address practice intentions. In the same units, retrospective patient’s data were collected to assess actual practice, compliance to nutrition guidelines and infant postnatal growth. The cumulative nutritional deficit during the two first weeks of life was calculated and variables associated with ΔZ-score for weight at 36 weeks postconceptional age/discharge (ΔZ-scorew 36PCA/DC) were analysed by multivariate linear regression.Results276 infants born 30 to 33 weeks of gestation were studied. Among them, 76 % received parenteral nutrition on central venous line after birth. On day of life 1 (DOL1), 93 % of infants had parenteral amino acids (AA), at an intake ≥ 1.5 g/kg in 27 % of cases. Lipids were started at ≤ DOL2 in 47 % of infants. There was a divergence between the intended and the actual practice for both AA and lipids intake. The AA and energy cumulative deficit (DOL1 to DOL14) were respectively 10.9 ± 8.3 g/kg and 483 ± 181 kcal/kg. Weight Z-score (mean ± SD) significantly decreased from birth (−0.17 ± 0.88) to 36 weeks PCA/DC (−1.00 ± 0.82) (p < 0.0001), and the extra-uterine growth retardation (EUGR) rate at 36 weeks PCA/DC was 24.2 %. Independent variables associated with ΔZ-scorew 36PCA/DC were AA cumulative intake and DOL of full enteral feeding.ConclusionsNutrition intake was not in compliance with recommendations, and the rate of EUGR was considerable in this cohort. Efforts are needed to improve adherence to nutrition guidelines and growth outcome of moderately preterm infants.
Highlights
The nutritional care provided to moderately premature babies is poorly studied
* Correspondence: silvia.iacobelli@chu-reunion.fr 1Centre d’Etudes Périnatales de l’Océan Indien, CHU La Réunion - Saint Pierre, BP 350 97448 Saint Pierre Cedex, France 2Néonatologie, Réanimation Néonatale et Pédiatrique, CHU La Réunion Saint Pierre, Saint Pierre Cedex BP 350 97448, France Full list of author information is available at the end of the article of continuous education, the carrying out of surveys to focus on trends in clinical practice [4, 5] and the adherence of postnatal nutrition to current recommendations, have been addressed as possible solutions for improving growth and reducing extra-uterine growth retardation (EUGR) [6, 7]. All this literature relates to extremely or very low birth weight (VLBW) infants and very little is known about the nutritional care of the more “healthy” but still immature babies, born between 30 and 33 weeks of gestational age (GA), even though they account for 15 % of preterm life births and 30 % of neonatal intensive care unit (NICU) admissions
This study shows the poor postnatal growth of a moderately premature population, demonstrating that both EUGR rate and cumulative nutritional deficit are considerable during the first weeks of life in infants born 30 to 33 weeks of gestation
Summary
The nutritional care provided to moderately premature babies is poorly studied. For a large cohort of such babies, we aimed to describe: nutrition practice intentions, comparison of the intended with the actual practice, compliance of actual practice to current nutrition guidelines, and postnatal growth. All this literature relates to extremely or very low birth weight (VLBW) infants and very little is known about the nutritional care of the more “healthy” but still immature babies, born between 30 and 33 weeks of gestational age (GA), even though they account for 15 % of preterm life births and 30 % of neonatal intensive care unit (NICU) admissions. To date, no study has evaluated the adherence to guidelines for energy and amino acids (AA) intake in this specific population. Infants within this cohort are generally less “sick” when compared with their very preterm counterparts and they have more subtle feeding issues and complications. They often require a limited technological support and the choice of avoiding the central venous line (CVL) insertion – in order to reduce the possible associated complications - may limit the supply of the recommended protein and caloric intake, especially during the transitional period [10]
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