Published online July 27, 2009
PEDIATRICS Vol. 124 No. 2 August 2009, pp. 649-657 (doi:10.1542/peds.2008-3258)

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ARTICLE

Nutritional Practices and Growth Velocity in the First Month of Life in Extremely Premature Infants

Camilia R. Martin, MD^a,b, Yolanda F. Brown, MD^b, Richard A. Ehrenkranz, MD^c, T. Michael O'Shea, MD, MPH^d, Elizabeth N. Allred, MS^e,f, Mandy B. Belfort, MD, MPH^b, Marie C. McCormick, MD, ScD^g, Alan Leviton, MD^e and the Extremely Low Gestational Age Newborns Study Investigators

^a Department of Neonatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
^b Division of Newborn Medicine
^e Neuroepidemiology Unit, Department of Neurology, Children's Hospital, Harvard Medical School, Boston, Massachusetts
^c Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut
^d Department of Pediatrics, Wake Forest University, Winston-Salem, North Carolina; Departments of
^f Biostatistics
^g Society, Human Development, and Health, Harvard School of Public Health, Boston, Massachusetts

OBJECTIVES: The goals of this study were to describe nutritional practices in the first month of life for a large cohort of extremely low gestational age newborns and to determine the impact of these nutritional practices on growth velocity (GV) over the same period.

METHODS: The sample included 1187 infants born at 23 to 27 weeks of gestation, at 14 institutions, between 2002 and 2004. Inclusion criteria included survival until day 28 and weight information for days 7 and 28. GV, expressed as grams per kilogram per day, was calculated for the interval between days 7 and 28. Nutritional practices during the first week and on days 14, 21, and 28 were compared with current nutritional guidelines in the literature. Multivariable logistic regression models estimated the contribution of limited nutrition to limited GV.

RESULTS: Protein and fat delivery approximated current nutritional recommendations, whereas carbohydrate and total energy intake delivery did not. Despite this, GV of our study infants exceeded the current guideline of 15 g/kg per day. Nevertheless, we found extrauterine growth restriction (ie, weight for gestational age below the 10th centile) in 75% of the infants at 28 days, compared with only 18% at birth. A GV of 20 to 30 g/kg per day was associated with infants' maintaining or exceeding their birth weight z score, with rates in the upper range for the gestationally youngest infants. Early (day 7) nutritional practices were positively associated with GV measured between days 7 and 28.

CONCLUSION: The early provision of nutrients is an important determinant of postnatal growth. Extrauterine growth restriction remains high in extremely premature infants even when they achieve a GV rate within current guidelines.

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Key Words: premature infant • nutrition • growth velocity

Abbreviations: GA—gestational age • ELGAN—extremely low gestational age newborn • GV—growth velocity • SNAP-II—Score for Neonatal Acute Physiology II

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Accepted Dec 1, 2008.

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