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Nutritional therapies in the neonatal intensive care unit and post‐natal growth outcomes of preterm very low birthweight Asian infants
Author(s) -
Lee Le Ye,
Lee Jiun,
Niduvaje Krishnamoorthy,
Seah Shirley SY,
Atmawidjaja Raymond W,
Cheah FookChoe
Publication year - 2020
Publication title -
journal of paediatrics and child health
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.631
H-Index - 76
eISSN - 1440-1754
pISSN - 1034-4810
DOI - 10.1111/jpc.14634
Subject(s) - medicine , pediatrics , neonatal intensive care unit , birth weight , low birth weight , enteral administration , ductus arteriosus , gestational age , breast milk , parenteral nutrition , pregnancy , genetics , biology , biochemistry , chemistry
Aim A collaborative study was conducted between two Southeast Asian university hospitals to compare the nutritional intervention and growth outcomes and evaluate the extent of post‐natal growth faltering (PNGF) among very low birthweight (VLBW) infants. Methods Data of all infants admitted during the 2011–2012 period to the two hospitals at Singapore (SG) and Malaysia (MY) were pooled and analysed. Results Of the 236 infants, SG infants received lower total protein and energy intake than MY infants (2.69 vs. 3.54 g/kg/day and 92.4 vs. 128.9 kcal/kg/day respectively; P < 0.001) in enteral feeds, with Singaporean infants predominantly fed fortified breast milk than Malaysian infants (45/48 vs. 10/41; P < 0.01). The mean weight z ‐score from birth to 36 weeks corrected age was significantly different (SG,−2.2 (0.9) vs. MY, −1.4 (0.7); P = 0.001). More SG than MY extremely low birthweight (ELBW) infants had severe PNGF >−2 SDS (55 vs. 16%; P = 0.001). The greater use of a diuretic in SG to treat haemodynamically significant patent ductus arteriosus (hsPDA) may have contributed to the higher PNGF rate. Mean growth velocity of at least 15 g/kg/day was attained by VLBW infants only from Day 14 and by ELBW infants only from Day 28 post‐natally. Overall, severe PNGF rates ( z ‐score change >−2 SDS at 36 weeks' corrected age) were 28.8 and 36.5% for VLBW and ELBW infants, respectively. Conclusions Being very preterm, ELBW with hsPDA and receiving insufficient protein and energy were risk factors for severe PNGF. Increasing protein and energy content, augmenting fortification of breast milk and concentrating feed volumes, especially if there is an hsPDA, may curb severe PNGF among these infants.