Abstract :
[en] Postnatal growth restriction (PNGR) is a common finding during neonatal hospitalization in very low birth weight (VLBW) infants. Insufficient nutritional support during the first weeks of life is responsible of major cumulative protein and energy deficit that has been considered as malnutrition. VLBW infants are frequently described small-for-gestational age (SGA) at discharge. The insufficient nutritional support is the primary aetiology of the PNGR observed in VLBW infants. Furthermore, both insufficient nutritional intakes and poor growth have been associated with adverse short and long-term outcomes. Particularly, they impair neurodevelopment and favor disorders in adulthood like obesity, type 2 diabetes, hypertension and cardiovascular diseases.
Despite the immaturity of VLBW infants, some authors have proposed to increased nutritional intakes from birth onwards and consider this early ‘‘aggressive’’ nutrition as more optimal.
This concept has been translated in the recent recommendations that advocate a minimum of 40 kcal/kg/day and 2.0 g/kg/day of protein from the first day of life that need to be increased to 120 kcal/kg/day and 3.8 g/kg/day of protein by the end of the first week of life.
A significant variation has been observed regarding nutritional practices among neonatal intensive care units with many studies still reporting insufficient postnatal nutritional intakes and severe PNGR. Some authors have questioned the feasibility and the adequacy of current nutritional recommendations. Indeed, there are still some concerns that increased nutritional intakes may disturb infant’s condition. Common fears include hyperglycemia, uremia, metabolic acidosis, hyperammoniemia and necrotizing enterocolitis.
The aim of this study was to evaluate postnatal growth, cumulative nutritional deficit and metabolic tolerance after optimizing our nutritional policy to recent recommendations.
The study is a prospective, observational, non interventional, and single-center cohort study in VLBW infants <1250g. All consecutive infants admitted in the NICU during a 2-year period were included in the study (N=102). Severely ill infants and infants with congenital anomalies were not excluded from the analysis.
This study is the first to demonstrate nutritional intakes in the range of current recommendations. It suggests that it is possible to optimize nutritional intakes routinely in real clinical practice. The use of an adequate standardized ready-to-use parenteral solution appears to contribute to improve the early nutritional supply.
Optimizing the energy and protein intakes significantly reduced the cumulative nutritional deficit, even in extremely preterm infants <28 weeks’ gestational age. In the majority of infants, PNGR could even be prevented. In our cohort, only 6% of appropriate-for-gestational age infants became SGA at discharge. Moreover, 20% of SGA infants became appropriate for gestational age at discharge. No major metabolic disturbances were observed and, even more, biological perturbations seem to decline compared to most recent studies.
Additionally, we evaluate the first commercially manufactured parenteral nutrition developed for preterm infants. Theses studies confirm that the first week of life is a critical period to promote growth. This study is an important step in neonatal intensive care. It demonstrates that malnutrition may be avoided in VLBW infants and that postnatal growth may be enhanced with little restriction by the time of discharge. It is an important contribution to the development of VLBW infants.
