Department of Pediatrics, University of Greifswald, Germany.
Clin Nutr. 2012 Feb;31(1):124-31. doi: 10.1016/j.clnu.2011.07.004. Epub 2011 Sep 3.
BACKGROUND & AIMS: The growth of very low birth weight infants does not match intrauterine trajectories, likely due to inappropriate caloric intake. We therefore investigated whether modification of the standard nutritional schedule can impact postnatal growth.
We introduced a set of evidence-based strategies in a study group of infants (n = 123): 1) higher maximum intake of intravenous amino acids and lipids; 2) prioritisation of earlier enteral feeding; 3) faster attainment of full enteral feeds; 4) daily adjustment of enteral feeds according to growth trajectory; and 5) utilisation of an electronic pre-structured prescription ordering system that tracks individual growth and energy intake. These infants were compared with a control group (n = 115) in a pre/post retrospective cohort study.
The study group achieved a higher caloric intake, attained full enteral feeds 5 days earlier, and returned to their birth weight more rapidly than the control group. At 36 weeks postmenstrual age, infants who had been born at <30 weeks were heavier (Δ260 g) but had a similar percentage fat mass. Those born at <28 weeks had a larger head circumference (Δ1.4 cm) and lower sepsis rate (7.8%).
Optimization of early postnatal nutrition and daily adjustment of milk intake according to weight gain improved growth, without any unfavourable outcomes for body composition and neurodevelopmental follow-up.
极低出生体重儿的生长速度与宫内生长轨迹不匹配，这可能是由于热量摄入不当。因此，我们研究了改变标准营养方案是否会影响出生后的生长。
我们在一个研究组的婴儿（n=123）中引入了一组基于证据的策略：1）增加静脉内氨基酸和脂肪的最大摄入量；2）优先进行早期肠内喂养；3）更快地达到全肠内喂养；4）根据生长轨迹每天调整肠内喂养量；5）利用电子预结构化处方订购系统跟踪个体生长和能量摄入。这些婴儿与对照组（n=115）在回顾性队列研究中进行了比较。
研究组的热量摄入更高，达到全肠内喂养的时间提前了 5 天，体重恢复到出生体重的速度也比对照组更快。在 36 周的校正胎龄时，出生时胎龄<30 周的婴儿体重更重（增加了 260g），但脂肪量百分比相似。出生胎龄<28 周的婴儿头围更大（增加了 1.4cm），败血症发生率更低（7.8%）。
优化早期的营养支持，根据体重增加情况每天调整奶量，可以改善生长，而不会对身体成分和神经发育随访产生任何不利影响。
