Avoiding Energy and Protein Defic its According to AAP Nutritional Recommendations fo r VLBW Infants Reduces Postnatal Undernutrition at 36 Weeks of Corrected Gestational Age?
Ricardo Nieto, Gaston Perez, Alejandro Dinerstein, Claudio Solana, Miguel Larguia, Rodolfo Raviolo. Maternidad Sarda, Argentina; Fresenius Kabi - Argentina
Nutrient intakes recommended by the AAP forvery low birth infants (VLBW) seem not to be achieved since, according to our own data, energy and proteindeficits are observed during hospitalization.
To evaluate if postnatal undernutrition canbe reduced, providing a nutritional intervention avoiding deficits in energy and protein intakes early after birth orcompensate them before 36 weeks corrected gestational age(cGA).
Newborns appropriate for GA <31 weeks,were randomized to a standard group (SG) who received the recommendations of the AAP for energy andcaloric intakes or an intensive intervention (IG), overpassing the usual guidelines, attempting to avoid or compensate for nutritional deficits. In the IG, enteralfeeding werestarted on the first day, increasing by 10 to 20 ml/kg/day until reaching 200 ml/kg/day of fortified humanmilk or premature s formula (24 Kcal/oz). Parenteralamino acids werestarted at birth at 1,5 g/kg/day with increments of 1g/kg until reaching 4.5 g/kg/day. Lipids were started by the second day, with 1 g/kg/day and increasing by 1 g/kgto amaximum of 3.5 g/k/d. When 100 kcal/kg/d were reached enterally, parenteral nutrition was discontinued.
From 7/2004 to 6/2005, 60 patients were born and 50 who survived up to 36 weeks cGA were evaluated, 28 in the IG and 22 in the SG. Mean birth weight(BW)and GA for the IG was 1098 g (±265) and 28.2 (±1.6)weeks, similar to those of the SG: 1127 g (±255) and 28.1 (±1.4) weeks. There were no differences in morbidity, exceptfor PDA, 62.5% in IG and 40% in SG (p:0.001). Undernutrition (weight < 10th percentile) was similar in both groups (36% vs 44%) at 36 weeks cGA. Despite the difference innutritional protocols, energy and protein intakes at 36weeks cGA were not different, with zero deficit in 63%in energy and 71% in protein in the SG vs. 64% and59% in the IGgroup.
An intensive nutritional interventionto avoid nutritional deficits did not eliminate postnatal undernutrition, which was however lower in bothgroups than ourhistorical rates. We speculate that the improvement innutritional care of the standard group was the main reason for the lack of differences in energy and protein intakes duringthe study period.