Postnatal longitudinal reference growth of very preterm infants on exclusive human milk feeding till discharge

Abstract

Background and objectivesGrowth measurements help to confirm an infant's healthy development and also help to identify early, potential health or nutritional problems. Appropriate Growth is also a criteria for early discharge of very preterm infants from NICU. To identify the infants who have growth faltering, we need to monitor the anthropometry regularly and compare with a local standard. Currently there is no best strategy of monitoring growth in VLBW infants. Objective of this study is to assess postnatal longitudinal growth for very preterm infants on Exclusive human milk feeding till discharge. Materials and methodsAll newborns with gestation <33 weeks at birth and admitted to the NICU included in this study. Those with major malformations, death before discharge and babies transferred to another hospital for care before 7 days were excluded. Nutritional and fluid management of all enrolled infants was guided by a nutritional protocol elaborating on both parenteral nutrition and enteral nutrition. All enrolled infants were on exclusive human milk (mothers own milk or donor human milk) till hospital discharge. All the discharged enrolled infants were followed up in the high risk follow up clinic weekly till the infant reached a post-menstrual gestational age of 37–40 weeks. Post-natal growth charts for each gestational age group was created using polynomial regression and linear regression. ResultsDuring the study period a total of 398 eligible infants were admitted to the neonatal units. After excluding 76 infants (36 died in hospital, 40 infants got shifted to another hospital before complete care), 322 infants were eligible for growth assessment. The average time to reach full feeds was 7.7 ± 5.2 days and time to regain birth weight was 12.2 ± 4.8 days. The average weight gain from time to regain birth weight till hospital discharge and till last PMA was 17.6 ± 16 gm/kg/day and 19.8 ± 8 gm/kg/day respectively. The rate of growth for length and head circumference in hospital and till last PMA was 0.8 ± 1 cm/week, 0.7 ± 0.4 cm/week and 0.38 ± 0.8 cm/week, 0.55 ± 0.7 cm/week respectively. The rate of growth in weight, length and head circumference differed significantly among the gestational age groups as shown in Charts. ConclusionInfants with exclusive fortified human milk feeding had growth rate very similar to in-utero growth from time to regain birth weight till hospital discharge or till last PMA at follow up.