Avoiding Energy and Protein Deficits According to AAP Nutritional Recommendations for 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 for very low birth infants (VLBW) seem not to be achieved since, according to our own data, energy and protein deficits are observed during hospitalization.
To evaluate if postnatal undernutrition can be reduced, providing a nutritional intervention avoiding deficits in energy and protein intakes early after birth or compensate 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 and caloric intakes or an intensive intervention (IG), overpassing the usual guidelines, attempting to avoid or compensate for nutritional deficits. In the IG, enteral feeding were started on the first day, increasing by 10 to 20 ml/kg/day until reaching 200 ml/kg/day of fortified human milk or premature s formula (24 Kcal/oz). Parenteral amino acids were started at birth at 1,5 g/kg/day with increments of 1 g/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/kg to a maximum 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, except for 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 in nutritional protocols, energy and protein intakes at 36 weeks cGA were not different, with zero deficit in 63% in energy and 71% in protein in the SG vs. 64% and 59% in the IG group.
An intensive nutritional intervention to avoid nutritional deficits did not eliminate postnatal undernutrition, which was however lower in both groups than our historical rates. We speculate that the improvement in nutritional care of the standard group was the main reason for the lack of differences in energy and protein intakes during the study period.
Tuesday, May 2, 2006
Poster Session: Poster Session IV (12:00 PM - 1:30 PM)
Board Number: 426
Course Number: 5571