Raturi Shilpee, Zheng Qishi, Daniel Lourdes M, Shi Luming, Rajadurai Victor S, Agarwal Pratibha K
Department of Child Development, KK Women's and Children's Hospital, Singapore.
Singapore Clinical Research Institute, Singapore.
J Paediatr Child Health. 2017 Dec;53(12):1199-1207. doi: 10.1111/jpc.13630. Epub 2017 Aug 18.
To describe nutritional practices among preterm extremely low-birthweight (ELBW) infants and their impact on growth and to compare differences in nutritional intervention and comorbidities between those with limited growth velocity (GV < 25th percentile) and those with GV > 25th percentile.
A prospective cohort study was conducted to assess total protein and energy intake for week 1, days 14, 21 and 28 of life. Post-natal growth was calculated by measuring GV using an exponential model. Univariable analysis was applied to identify the potential risk factors associated with poor GV at day 28 and at discharge from hospital.
The median GV from birth to day 28 was 9.84 g/kg/day and 11.87 g/kg/day for GV from birth to discharge. Increased protein and energy intake was associated with higher GV at discharge. Hypotension needing inotropes, necrotising enterocolitis (NEC), patent ductus arteriosus and chronic lung disease were significantly associated with reduced GV at discharge. Infants with NEC, hypotension needing inotropes and sepsis took a significantly longer time to achieve full enteral nutrition. A longer time to attain full enteral feeds was associated with slower GV at discharge. Small-for-gestational-age babies increased from 22% at birth to 66.6% at discharge.
GV at discharge was positively correlated with increasing protein and energy intake in the first 28 days and adversely affected by the presence of neonatal morbidities. There was strong evidence of extra-uterine growth restriction, with the majority of preterm ELBW infants having lower z scores at discharge compared to at birth.
描述极早早产儿（ELBW）的营养实践及其对生长的影响，并比较生长速度有限（GV<第25百分位数）和GV>第25百分位数的婴儿在营养干预和合并症方面的差异。
进行一项前瞻性队列研究，以评估出生后第1周、第14天、第21天和第28天的总蛋白质和能量摄入量。通过使用指数模型测量GV来计算出生后的生长情况。应用单变量分析来确定与出生后第28天和出院时GV不佳相关的潜在风险因素。
从出生到第28天的GV中位数为9.84克/千克/天，从出生到出院的GV中位数为11.87克/千克/天。蛋白质和能量摄入量增加与出院时较高的GV相关。需要使用血管活性药物的低血压、坏死性小肠结肠炎（NEC）、动脉导管未闭和慢性肺病与出院时GV降低显著相关。患有NEC、需要使用血管活性药物的低血压和败血症的婴儿实现完全肠内营养的时间明显更长。达到完全肠内喂养的时间越长，出院时的GV越慢。小于胎龄儿从出生时的22%增加到出院时的66.6%。
出院时的GV与出生后前28天蛋白质和能量摄入量的增加呈正相关，并受到新生儿疾病的不利影响。有强有力的证据表明存在宫外生长受限，与出生时相比，大多数极早早产儿出院时的z评分较低。
