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Nutrient intakes independently affect growth in extremely preterm infants: results from a population-based study
Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
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2013 (English)In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 102, no 11, 1067-1074 p.Article in journal (Refereed) Published
Abstract [en]

Aim To explore associations between energy and macronutrient intakes and early growth in extremely low gestational age (ELGA) infants.

Methods Retrospective population-based study of all ELGA infants (<27weeks) born in Sweden during 2004-2007. Detailed data on nutrition and anthropometric measurements from birth to 70days of postnatal age were retrieved from hospital records.

Results Study infants (n=531) had a meanSD gestational age of 25.3 +/- 1.1weeks and a birth weight of 765 +/- 170g. Between 0 and 70 days, average daily energy and protein intakes were 120 +/- 11kcal/kg and 3.2 +/- 0.4g/kg, respectively. During this period, standard deviation scores for weight, length and head circumference decreased by 1.4, 2.3 and 0.7, respectively. Taking gestational age, baseline anthropometrics and severity of illness into account, lower energy intake correlated with lower gain in weight (r=+0.315, p<0.001), length (r=+0.215, p<0.001) and head circumference (r=+0.218, p<0.001). Protein intake predicted growth in all anthropometric outcomes, and fat intake was positively associated with head circumference growth.

Conclusion Extremely low gestational age infants received considerably less energy and protein than recommended and showed postnatal growth failure. Nutrient intakes were independent predictors of growth even after adjusting for severity of illness. These findings suggest that optimized energy and macronutrient intakes may prevent early growth failure in these infants.

Place, publisher, year, edition, pages
Wiley-Blackwell, 2013. Vol. 102, no 11, 1067-1074 p.
Keyword [en]
Energy intake, Extremely preterm infants, Growth failure, Nutrient intake, Protein
National Category
URN: urn:nbn:se:umu:diva-82606DOI: 10.1111/apa.12359ISI: 000325265500021OAI: diva2:663343
Available from: 2013-11-11 Created: 2013-11-05 Last updated: 2014-05-19Bibliographically approved
In thesis
1. The impact of early nutrition on extremely preterm infants
Open this publication in new window or tab >>The impact of early nutrition on extremely preterm infants
2014 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background Modern neonatal care has improved the survival rate of extremely preterm infants. These infants are at high risk of malnutrition and growth failure during 3-4 months of hospital care. The objectives of this study was to investigate nutritional intakes during hospitalization and explore associations between nutritional intakes, postnatal growth and retinopathy of prematurity (ROP). Perioperative nutrition in infants undergoing surgery for patent ductus arteriosus (PDA) was also investigated.

Methods This is a population-based study of Swedish extremely preterm infants (<27 weeks) born during 2004-2007 (n=602). Detailed data on nutritional supply and anthropometric measurements during hospitalization were retrospectively retrieved from hospital records. Comprehensive data on cohort characteristics, neonatal morbidity and infant mortality were obtained from the Extremely Preterm Infants in Sweden Study (EXPRESS).

Results During the first 70 days of life, intakes of energy, protein and several micronutrients, with the exception of iron and some vitamins, were less than estimated requirements, and infants showed severe postnatal growth failure. Energy and protein intake predicted growth in all anthropometric outcomes even when adjusting for severity of illness, and fat intake was positively associated with head growth. Low folate intake was positively correlated with poor weight and length gain while high iron intake, mainly explained by blood transfusions, was negatively associated with poor length gain. Furthermore, a low energy intake was associated with severe ROP (stage 3-5). An increased energy intake of 10 kcal/kg/d was associated with 24% decrease in severe ROP (p=0.01). During the first month, 99% of the infants were exclusively fed human milk. Infants who underwent surgery for PDA (n=140) were malnourished, with energy and macronutrient intakes below minimum estimated requirements before, during and after surgery.

Conclusions The severe postnatal growth failure observed in Swedish extremely preterm infants may be prevented by improved intakes of energy, protein, fat and folate and a reduction of the number of blood transfusions. Human milk is the main enteral food source and analyses of human milk macronutrient contents facilitates individualized fortification. Provision of adequate energy intakes during the first four weeks of life may be an effective way to reduce the risk of severe ROP. Perioperative nutrition in infants undergoing PDA surgery needs to be improved. The study results have important implications for nutritional regimens, postnatal growth and health outcome in this new generation of survivors.

Place, publisher, year, edition, pages
Umeå: Umeå universitet, 2014. 65 p.
Umeå University medical dissertations, ISSN 0346-6612 ; 1642
Energy intake, enteral intake, extremely preterm infants, folate, growth failure, human milk, iron, macronutrients, malnutrition, micronutrients, nutrient intake, patent ductus arteriosus, protein, retinopathy of prematurity, surgery
National Category
Pediatrics Nutrition and Dietetics
urn:nbn:se:umu:diva-88461 (URN)978-91-7601-039-6 (ISBN)
Public defence
2014-05-28, Sal 135, by 9A, Norrlands Universitetssjukhus, Umeå, 13:00 (English)
Available from: 2014-05-07 Created: 2014-05-06 Last updated: 2014-05-07Bibliographically approved

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