Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada.
SickKids Research Institute, Toronto, Ontario, Canada.
JPEN J Parenter Enteral Nutr. 2018 Mar;42(3):623-632. doi: 10.1177/0148607117710441. Epub 2017 Dec 19.
Serious morbidity may elevate nutrient requirements and affect adherence to feeding guidelines for very low birth weight (VLBW) infants. An understanding of factors affecting nutrient intakes of VLBW infants will facilitate development of strategies to improve nutrient provision. Our aim was to examine the impact of neonatal morbidity count on achieving recommended nutrient intakes in VLBW infants.
VLBW infants enrolled in the Donor Milk for Improved Neurodevelopmental Outcomes trial (ISRCTN35317141, n = 363) were included. Serious morbidities and daily parenteral and enteral intakes were collected prospectively.
Median intakes of infants with and without ≥1 morbidity met protein recommendations (3.5-4.5 g/kg/d) by week 2, although not maintained after week 4. Infants with ≥1 morbidity (vs without) were 2 weeks slower in achieving lipid (4.8-6.6 g/kg/d; week 4 vs 2) and energy (110-130 kcal/kg/d; week 5 vs 3) and 1 week slower in achieving carbohydrate recommendations (11.6-13.2 g/kg/d; week 4 vs 3). Adjusted hazard ratios of first achieving recommendations on any given day in infants with any 1 or 2 morbidities were 0.6 (95% confidence interval [CI], 0.5-0.9) and 0.6 (0.4-0.9), respectively, for protein; 0.5 (0.4-0.7) and 0.3 (0.2-0.5) for lipid; and 0.5 (0.4-0.7) and 0.3 (0.2-0.4) for energy.
Morbidity is associated with a decreased likelihood of achieving lipid and consequently energy recommendations. This and the decline in protein intakes after the early neonatal period require further investigation to ensure optimal nutrition in this vulnerable population.
严重的发病率可能会增加营养需求，并影响极低出生体重（VLBW）婴儿对喂养指南的依从性。了解影响 VLBW 婴儿营养摄入量的因素将有助于制定改善营养供应的策略。我们的目的是研究新生儿发病率对 VLBW 婴儿达到推荐营养摄入量的影响。
纳入了参加母乳促进神经发育结局改善试验（ISRCTN35317141，n=363）的 VLBW 婴儿。前瞻性收集严重疾病和每日肠外和肠内摄入量。
有≥1 种疾病的婴儿与无≥1 种疾病的婴儿的中位数摄入量在第 2 周达到蛋白质推荐摄入量（3.5-4.5 g/kg/d），但在第 4 周后无法维持。有≥1 种疾病（与无疾病相比）的婴儿在第 4 周达到脂质（4.8-6.6 g/kg/d；第 4 周比第 2 周）和能量（110-130 kcal/kg/d；第 5 周比第 3 周）以及在第 4 周达到碳水化合物推荐摄入量（11.6-13.2 g/kg/d；第 4 周比第 3 周）的速度慢了 2 周。有 1 种或 2 种疾病的婴儿在任何一天首次达到任何一种推荐摄入量的调整后危险比分别为 0.6（95%置信区间 [CI]，0.5-0.9）和 0.6（0.4-0.9）用于蛋白质；0.5（0.4-0.7）和 0.3（0.2-0.5）用于脂质；0.5（0.4-0.7）和 0.3（0.2-0.4）用于能量。
发病率与达到脂质和因此能量推荐的可能性降低有关。这一点以及蛋白质摄入量在新生儿期后下降，需要进一步研究，以确保这一脆弱人群的最佳营养。
