Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.
Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.
JPEN J Parenter Enteral Nutr. 2018 May;42(4):805-812. doi: 10.1177/0148607117722927. Epub 2017 Dec 22.
Very low birth weight (VLBW) infants remain at risk for postnatal growth restriction. Clinicians may have difficulty identifying growth patterns resulting from nutrition interventions, impeding prompt management changes intended to increase growth velocity. This study aimed to quantify the association between growth and nutrition intake through 7-day moving averages (SDMAs).
The first 6 weeks of daily nutrition intake and growth measurements were collected from VLBW infants admitted to a level 4 neonatal intensive care unit (2011-2014). The association between SDMA for energy and macronutrients and subsequent 7-day growth velocities for weight, length, and head circumference were determined using mixed effects linear regression. Analyses were adjusted for fluid intake, infant characteristics, and comorbid conditions.
Detailed enteral and parenteral caloric provisions were ascertained for 115 infants (n = 4643 patient-days). Each 10-kcal/kg/d increase over 7 days was independently associated with increased weight (1.7 g/kg/d), length (0.4 mm/wk), and head circumference (0.9 mm/wk; P < .001, for weight and head circumference; P = .041 for length). Each 1 g/kg/d macronutrient increase was also associated with increased weight (protein, P = .027; fat and carbohydrates, P < .001), increased length (fat, P = .032), and increased head circumference (fat and carbohydrates, P < .001).
The SDMA identifies clinically meaningful associations among total energy, macronutrient dosing, and growth in VLBW infants. Whether SDMA is a clinically useful tool for providing clinicians with prompt feedback to improve growth warrants further attention.
极低出生体重（VLBW）婴儿仍然存在产后生长受限的风险。临床医生可能难以识别营养干预措施导致的生长模式，从而阻碍了旨在增加生长速度的及时管理变更。本研究旨在通过 7 天移动平均值（SDMA）量化生长与营养摄入之间的关联。
从入住 4 级新生儿重症监护病房（2011-2014 年）的极低出生体重儿中收集了前 6 周的每日营养摄入和生长测量值。使用混合效应线性回归确定能量和宏量营养素的 SDMA 与随后 7 天体重、长度和头围生长速度之间的关联。分析调整了液体摄入、婴儿特征和合并症。
确定了 115 名婴儿（n = 4643 个患者日）的详细肠内和肠外热量供应。7 天内每增加 10 千卡/公斤/天与体重增加（1.7 克/公斤/天）、长度增加（0.4 毫米/周）和头围增加（0.9 毫米/周；P <.001，体重和头围；P =.041，长度）独立相关。每增加 1 克/公斤/天的宏量营养素也与体重增加（蛋白质，P =.027；脂肪和碳水化合物，P <.001）、长度增加（脂肪，P =.032）和头围增加（脂肪和碳水化合物，P <.001）相关。
SDMA 确定了极低出生体重儿总能量、宏量营养素剂量与生长之间具有临床意义的关联。SDMA 是否是为临床医生提供及时反馈以改善生长的有用工具值得进一步关注。
