Enhanced feeding and diminished postnatal growth failure in very-low-birth-weight infants

Sissel J Moltu, Elin W Blakstad, Kenneth Strømmen, Astrid N Almaas, Britt Nakstad, Arild Rønnestad, Kristin Brække, Marit B Veierød, Christian A Drevon, Per O Iversen, Ane C Westerberg, Sissel J Moltu, Elin W Blakstad, Kenneth Strømmen, Astrid N Almaas, Britt Nakstad, Arild Rønnestad, Kristin Brække, Marit B Veierød, Christian A Drevon, Per O Iversen, Ane C Westerberg

Abstract

Objective: The aim of the present study was to determine whether an increased supply of energy, protein, essential fatty acids, and vitamin A reduces postnatal growth failure in very-low-birth-weight infants.

Methods: Fifty infants with birth weight <1500 g were randomized to an intervention (n = 24) or a control (n = 26) feeding protocol within 24 hours after birth. Forty-four infants were included in the final analysis. This study was discontinued because of an increased occurrence of septicemia in the intervention group.

Results: The intervention group had a lower mean birth weight (P = 0.03) and a higher proportion of infants small-for-gestational age (P = 0.04) than the control group. Other baseline characteristics were similar. The median (interquartile range) energy and protein supplies during the first 4 weeks of life were higher in the intervention group: 139 (128-145) versus 126 (121-128) kcal · kg · day (P < 0.001) and 4.0 (3.9-4.2) versus 3.2 (3.1-3.3) g · kg · day (P < 0.001). The infants in the intervention group regained birth weight faster (P = 0.001) and maintained their z scores for weight and head circumference from birth to 36 weeks' postmenstrual age (both P < 0.001). The median (interquartile range) growth velocity was 17.4 (16.3-18.6) g · kg · day in the intervention group and 13.8 (13.2-15.5) g · kg · day in the control group (P < 0.001). In line with the improved growth in the intervention group, the proportion of growth-restricted infants was 11 of 23 both at birth and at 36 weeks' postmenstrual age, whereas this proportion increased among the controls from 4 of 21 to 13 of 21 (P = 0.04).

Conclusions: Enhanced supply of energy, protein, essential fatty acids, and vitamin A caused postnatal growth along the birth percentiles for both weight and head circumference.

Figures

FIGURE 1
FIGURE 1
Flowchart of study participants. PMA = postmenstrual age; VLBW = very-low-birth-weight.
FIGURE 2
FIGURE 2
Average weight z score change in the control and intervention groups from birth to 4 weeks of age. Means and 95% confidence interval, n = 44.

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