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The impact of early nutrition on extremely preterm infants
Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
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.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1642
Keyword [en]
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
Identifiers
URN: urn:nbn:se:umu:diva-88461ISBN: 978-91-7601-039-6 (print)OAI: oai:DiVA.org:umu-88461DiVA: diva2:715906
Public defence
2014-05-28, Sal 135, by 9A, Norrlands Universitetssjukhus, Umeå, 13:00 (English)
Opponent
Supervisors
Available from: 2014-05-07 Created: 2014-05-06 Last updated: 2014-05-07Bibliographically approved
List of papers
1. Nutrient intakes independently affect growth in extremely preterm infants: results from a population-based study
Open this publication in new window or tab >>Nutrient intakes independently affect growth in extremely preterm infants: results from a population-based study
Show others...
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
Keyword
Energy intake, Extremely preterm infants, Growth failure, Nutrient intake, Protein
National Category
Pediatrics
Identifiers
urn:nbn:se:umu:diva-82606 (URN)10.1111/apa.12359 (DOI)000325265500021 ()
Available from: 2013-11-11 Created: 2013-11-05 Last updated: 2017-12-06Bibliographically approved
2. Intakes of micronutrients is associated with early growth in extremely preterm infants: a population-based study
Open this publication in new window or tab >>Intakes of micronutrients is associated with early growth in extremely preterm infants: a population-based study
(English)Manuscript (preprint) (Other academic)
Abstract [en]

Objectives: To describe micronutrient intakes and explore possible correlations to growth during the first 70 days of life in extremely preterm infants.

Methods: Retrospective population-based study including extremely preterm infants (<27 weeks) born in Sweden during 2004-2007. Detailed nutritional and growth data were derived from hospital records.

Results: Included infants (n=531), had a mean gestational age of 25 weeks+2 days and a mean birth weight of 765 g. Intakes of calcium, phosphorus magnesium, zinc, copper, iodine, vitamin D and folate were lower than estimated requirements while intakes of iron, vitamin K and several water-soluble vitamins were higher than estimated requirements. High iron intakes were explained by blood transfusions. During the first 70 days of life, taking macronutrient intakes and severity of illness into account, folate intakes were positively correlated with weight (p=0.001) and length gain (p=0.003) and iron intake was negatively associated with length gain (p=0.006).

Conclusions: Intakes of many micronutrients were insufficient. Even when considering macronutrient intakes and severity of illness, several micronutrients were independent predictors of early growth. Low intakes of folate were associated with poor weight and length growth. Further, high iron intakes were associated with poor length and head circumference growth. Optimized early micronutrient intakes may improve early growth in extremely preterm infants.

Keyword
Extremely preterm infants, Folate, Growth, Iron, Micronutrients
National Category
Nutrition and Dietetics Pediatrics
Research subject
Pediatrics
Identifiers
urn:nbn:se:umu:diva-88452 (URN)
Available from: 2014-05-06 Created: 2014-05-06 Last updated: 2014-05-07Bibliographically approved
3. Low energy intake during the first 4 weeks of life increases the risk for severe retinopathy of prematurity in extremely preterm infants
Open this publication in new window or tab >>Low energy intake during the first 4 weeks of life increases the risk for severe retinopathy of prematurity in extremely preterm infants
Show others...
2016 (English)In: Archives of Disease in Childhood: Fetal and Neonatal Edition, ISSN 1359-2998, E-ISSN 1468-2052, Vol. 101, no 2, F108-F113 p.Article in journal (Refereed) Published
Abstract [en]

Objectives: Poor weight gain during the first weeks of life in preterm infants is closely associated with the risk of developing retinopathy of prematurity (ROP) and insufficient nutrition might be an important contributing factor. This study aimed to evaluate the effect of energy and macronutrient intakes during the first four weeks of life on the risk for severe ROP.

Study design: Population-based study including all Swedish extremely preterm infants born before 27 gestational weeks during a 3-year period. Each infant was classified according to the maximum stage of ROP in either eye as assessed prospectively until full retinal vascularization. Detailed daily data of actual intakes of enteral and parenteral nutrition as well as growth data were obtained from hospital records.

Results: Of the included 498 infants, 172 (34.5 %) had severe ROP (stages 3-5) and 96 (19.3 %) were treated. Energy and macronutrient intakes were less than recommended and the infants showed severe postnatal growth failure. Higher intakes of energy, fat and carbohydrates, but not protein, were significantly associated with a lower risk of severe ROP. Adjusting for morbidity, an increased energy intake of 10kcal/kg/d was associated with a 24 % decrease in severe ROP (p<0.01).

Conclusions: We showed that energy intake during the first four weeks of life was an independent risk factor for severe ROP. This implies that provision of adequate energy from parenteral and enteral sources during the first four weeks of life may be an effective method for reducing the risk of severe ROP in extremely preterm infants.

Keyword
Growth failure, Macronutrients, Malnutrition, Nutritional intakes, Preterm infants
National Category
Nutrition and Dietetics Pediatrics
Research subject
Pediatrics
Identifiers
urn:nbn:se:umu:diva-88459 (URN)10.1136/archdischild-2014-306816 (DOI)000371325900005 ()
Available from: 2014-05-06 Created: 2014-05-06 Last updated: 2017-12-05Bibliographically approved
4. Intake and macronutrient content in human milk given to extremely preterm infants
Open this publication in new window or tab >>Intake and macronutrient content in human milk given to extremely preterm infants
(English)Manuscript (preprint) (Other academic)
Abstract [en]

Background: Human milk (HM) is the preferred basis of nutrition for infants, including those born prematurely. Information on macronutrient content in HM is necessary to optimize nutritional support of preterm infants.

Objectives: To describe the types and amounts of enteral feeds given to Swedish extremely preterm infants during hospitalization and to investigate the energy and macronutrient content in HM given to these infants.

­Methods: A population-based study of Swedish extremely preterm infants (n=586) born before 27 gestational weeks. Data on ingested volumes of different milks during hospitalization and analyses of macronutrient content in HM samples were obtained from hospital records. Nutritional content of HM was determined by mid-infrared spectrophotometry analysis.

Results: During the first four weeks of life, 99% of the infants were exclusively fed HM and at four weeks of life, 70% of the infants received only mother’s own milk (MOM). Nutritional content in 821 MOM samples were analyzed. Protein content in MOM decreased significantly from 2.2g to 1.2g/100 mL during the first 112 postpartum days, while fat and energy content were highly variable within and between MOM samples. Additionally, 354 samples of donor milk were analyzed. Content of protein, fat and energy in pooled donor milk (n=129) were lower compared to single donor milk.

Conclusions: Swedish extremely preterm infants receive MOM to a large extent during hospitalization. Protein, carbohydrates and energy in MOM changed significantly with time. Weekly analyses of MOM during the first month of lactation would allow a more individualized nutritional support to these vulnerable infants.

Keyword
Donor milk, Enteral nutrition, Extremely preterm infants, Human milk, Neonatal nutrition, Protein
National Category
Medical and Health Sciences
Research subject
Pediatrics
Identifiers
urn:nbn:se:umu:diva-88462 (URN)
Available from: 2014-05-06 Created: 2014-05-06 Last updated: 2014-05-07Bibliographically approved
5. Perioperative nutrition in extremely preterm infants undergoing surgical treatment for patent ductus arteriosus is suboptimal
Open this publication in new window or tab >>Perioperative nutrition in extremely preterm infants undergoing surgical treatment for patent ductus arteriosus is suboptimal
Show others...
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
Keyword
extremely preterm infants, macronutrients, malnutrition, patent ductus arteriosus, surgery
National Category
Pediatrics
Research subject
Pediatrics
Identifiers
urn:nbn:se:umu:diva-83490 (URN)10.1111/apa.12497 (DOI)000331270000022 ()24205823 (PubMedID)
Available from: 2013-11-27 Created: 2013-11-27 Last updated: 2017-12-06Bibliographically approved

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Citation style
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  • ieee
  • modern-language-association-8th-edition
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