A standardized feeding protocol ensured recommended nutrient intakes and prevented growth faltering in preterm infants < 29 weeks gestation

Madelaine Eloranta Rossholt; Marianne Bratlie; Kristina Wendel; Marlen Fossan Aas; Gunnthorunn Gunnarsdottir; Drude Fugelseth; Tom Stiris; Magnus Domellöf; Ketil Størdal; Sissel Jennifer Moltu

doi:10.1016/j.clnesp.2022.12.024

A standardized feeding protocol ensured recommended nutrient intakes and prevented growth faltering in preterm infants < 29 weeks gestation

Clin Nutr ESPEN. 2023 Feb:53:251-259. doi: 10.1016/j.clnesp.2022.12.024. Epub 2022 Dec 28.

Affiliations

¹ Department of Neonatal Intensive Care, Oslo University Hospital, Norway; Department of Pediatrics and Adolescence Medicine, Oslo University Hospital, Norway; Institute of Clinical Medicine, University of Oslo, Norway. Electronic address: madros@ous-hf.no.
² Department of Neonatal Intensive Care, Oslo University Hospital, Norway; Department of Pediatrics and Adolescence Medicine, Oslo University Hospital, Norway; Institute of Clinical Medicine, University of Oslo, Norway.
³ Department of Neonatal Intensive Care, Oslo University Hospital, Norway; Institute of Clinical Medicine, University of Oslo, Norway.
⁴ Institute of Clinical Medicine, University of Oslo, Norway; Department of Pediatric Neurology, Oslo University Hospital, Norway.
⁵ Department of Clinical Sciences, Pediatrics, Umea University, Sweden.
⁶ Department of Pediatrics and Adolescence Medicine, Oslo University Hospital, Norway; Institute of Clinical Medicine, University of Oslo, Norway.

PMID: 36657920
DOI: 10.1016/j.clnesp.2022.12.024

Abstract

Background & aims: Nutrition is a cornerstone of postnatal care to prevent compromised growth and support short- and long-term health outcomes in preterm infants. We aimed to evaluate nutritional intakes and growth among infants <29 weeks gestation after implementation of a standardized feeding protocol.

Methods: This is an observational cohort secondary analysis of data from the ImNuT study (Immature, Nutrition Therapy, NCT03555019). To reduce variations in nutritional practice and ensure accommodation to current guidelines, we developed a standardized feeding protocol. Detailed information on actual nutritional intakes, growth and biochemistry was prospectively collected and assessed from birth to 36 weeks postmenstrual age (PMA).

Results: Median (range) gestational age and birth weight were 26⁺⁶ (22⁺⁶-28⁺⁶) weeks and 798 (444-1485) g. Energy and macronutrient intakes progressively increased from birth through transition to exclusive enteral feeds. Parenteral nutrition was weaned at median (IQR) day 11 (9, 14) when nutritional requirements were met by exclusively enteral feeds. Infants exhibited a median (IQR) weight loss of 7.8% (5.7, 11.6) and regained birth weight by day 8 (7, 11). Average velocity in weight, length and head circumference from birth to 36 weeks PMA were in accordance with target growth rates; median (IQR) 15.8 (14.7, 17.7) g/kg/d, 1.1 (0.98, 1.3) cm/week and 0.82 (0.83, 0.89) cm/week. At 36 weeks PMA, only 3% of infants exhibited moderate growth faltering (decline in weigh-for-age z score >1.2 from birth), and none severe.

Conclusions: In infants <29 weeks gestation, the standardized feeding protocol was well tolerated. Nutrient intakes and growth were close to recommendations.

Keywords: Body composition; Growth; Macronutrients; Nutrition; Preterm infants; Standardized feeding protocol.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Birth Weight
Eating*
Female
Gestational Age
Humans
Infant
Infant, Newborn
Infant, Premature*
Nutritional Requirements
Observational Studies as Topic
Pregnancy