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Perioperative nutrition in extremely preterm infants undergoing surgical treatment for patent ductus arteriosus is suboptimal
Karolinska Institutet, Stockholm.
Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
Uppsala University, Uppsala.
Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
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2014 (English)In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 103, no 3, 282-288 p.Article in journal (Refereed) Published
Abstract [en]

AIM: To evaluate perioperative nutrition in extremely preterm infants undergoing surgery for patent ductus arteriousus (PDA).

METHODS: Population-based study of extremely preterm infants born in Sweden during 2004-2007 and operated on for PDA. Data on perioperative nutrition was obtained from hospital records. All enteral and parenteral nutrients and blood products were used to calculate daily nutritional intakes, starting three days before and ending three days after surgery. Data are mean (95% confidence intervals).

RESULTS: Study infants (n=140) had a mean gestational age of 24.8 weeks and mean birth weight was 723 gram. Energy and macronutrient intakes were below minimal requirements before, during and after PDA surgery. On the day of surgery, energy intake was 78(74-81) kcal/kg/d, protein 2.9(2.7-3.2) g/kg/d, fat 2.5(2.3-2.7) g/kg/d and carbohydrate intake was 10.7(10.2-11.2) g/kg/d. Nutrition did not vary in relation to GA, but infants operated early (0-6 days after birth) received poorer nutrition than infants operated at older age. Fluid intake was 164(159-169) mL/kg/d, and it did not vary during the week of surgery.

CONCLUSIONS: Perioperative nutrition in extremely preterm infants undergoing PDA surgery in Sweden is suboptimal and needs to be improved. The significance of malnutrition for outcome after PDA surgery remains unclear and requires further investigation.

Place, publisher, year, edition, pages
John Wiley & Sons, 2014. Vol. 103, no 3, 282-288 p.
Keyword [en]
extremely preterm infants, macronutrients, malnutrition, patent ductus arteriosus, surgery
National Category
Research subject
URN: urn:nbn:se:umu:diva-83490DOI: 10.1111/apa.12497ISI: 000331270000022PubMedID: 24205823OAI: diva2:667646
Available from: 2013-11-27 Created: 2013-11-27 Last updated: 2014-05-07Bibliographically 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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