Early and aggressive nutritional strategy (parenteral and enteral) decreases postnatal growth failure in very low birth weight infants.

OBJECTIVE

To compare postnatal growth and nutritional deficits after the implementation of two different nutritional strategies in two consecutives periods of time.

METHODS

An early and aggressive nutritional regimen was used in a cohort of 117 very low birth weight (VLBW) infants. Amino acids were administered at the rate of 1.5 g/kg/day along with 5.6 mg/k/min of glucose flow on day 1 of life, and progressively increased to 4 g/kg/day and 13 mg/kg/min. Intravenous lipids were started at 0.5 g/kg/day at 24 h from birth, and increased to 3.5 g/kg/day; enteral feeding was begun at day 1 of life. Uni- and multivariate analyses were used to compare this group with the conventional group of 65 VLBW infants conservatively fed.

RESULTS

Univariate analysis showed that in the aggressive group there was a 66% reduction in the risk of post natal malnutrition at 40 weeks of postmenstrual age (OR 0.34; 95% CI 0.17-0.67). This difference persisted in the multivariate analysis. Energy and protein deficits were lower in the aggressive group (P < 0.001).

CONCLUSIONS

Early and aggressive introduction of total parenteral nutrition and enteral feeding resulted in better growth in weight, length and head circumference, and a reduction of nutritional deficits at 40 weeks of postmenstrual age.