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Selected Publication:
Khan, Z.
THE IMPACT OF NUTRIENT TIMING AND STRATEGY ON GROWTH OF PRETERM INFANTS FROM BIRTH TO DISCHARGE: PROSPECTIVE ANALYSIS OF A LARGE CLINICAL SAMPLE ACCORDING TO ESPGHAN-GUIDELINES
Doktoratsstudium der Medizinischen Wissenschaft; Humanmedizin; [ Dissertation ] Graz Medical University; 2016. pp.
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- Authors Med Uni Graz:
- Advisor:
- Holasek Sandra Johanna
- Urlesberger Berndt
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- Abstract:
- Background: Preterm birth is a medical emergency and an advanced medical proficiency with suitable infrastructure is required for survival against the numerous odds of the extrauterine environment. It is becoming evident that adequate nutrition starting in the first hours of life is of major importance for short and even more so for long-term health outcomes of the premature newborn. There are separate guidelines for parenteral nutrition and enteral nutrition for preterm infants. Clinicians need to develop unit-specific feeding protocols combining parenteral and enteral nutritional support to meet the daily nutrient requirements. Aim: To analyze the effective individual postnatal nutrient supply and growth patterns in response to standardized feeding protocol provided to preterm infants during their stay at NICU. Methods: A prospective cohort study was conducted including preterm infants born <32 weeks entering the NICU during a1-year-time period. Macronutrient, fluid and energy supply was recorded daily during their stay at NICU. Weight was recorded daily; head circumference and length were recorded weekly. Infants were divided in two groups on the basis of Gestational Age (GA): <28 weeks (Extremely preterm infants (EPI); and >28 weeks (very preterm infants (VPI). Results: 83 infants were included in analysis. EPI (n = 27) compared to VPI (n = 56) stayed longer on parenteral nutrition, needed more time to reach FEN, required more days on ventilation and had a higher corrected age at discharge. Moreover, fortification of enteral feeds was initiated later in EPI vs VPI (p< 0.001). As a consequence, cumulative supply of protein, fat and energy was significantly lower in EPI during the first five weeks of life. However, both groups exceeded the ESPGHAN recommended glucose intake in week 5. At discharge, we found significant differences in all growth parameters and body composition between both groups (weight Z scores: EPI=-1.19 vs VPI= -0.71; p<0.001, length Z scores: EPI=-1.62 vs VPI=-0.84; p<0.01; HC Z scores: EPI=-1.19 vs VPI=-0.46; p<0.01, BF%: EPI=18.6 Vs VPI=14.1; p< 0.01). At discharge EPI were lighter and shorter than VPI but exhibited higher body fat percentage. Conclusion: After implementation of a standardized evidence-based nutritional support protocol, nutrient supply and growth rate was variable in both groups during the observation period. Very preterm infants could achieve better Z-scores at discharge accompanied by body composition comparable to full-term new born infants. However, in extremely preterm infants, the complicated course of nutritional support during their stay at NICU influenced growth and body composition at discharge. In extremely preterm infants at risk of not making significant progress in escalating enteral intake, it seems prudent to practice aggressive parenteral nutritional support. If enteral feeds are tolerated well, fortification should be initiated at enteral volumes of 100ml/kg/d or even earlier. Moreover, the use of mother milk fortifier resulted in glucose intake above the ESPGHAN recommendations in later weeks –this need to be evaluated in future studies.