Service de Néonatologie, Hospices Civils de Lyon, Hôpital Universitaire de La Croix-Rousse, 103 Grande Rue de La Croix-Rousse, 69004, Lyon, 69677, France.
Centre de Recherche Clinique, Hospices Civils de Lyon, Hôpital Universitaire de La Croix-Rousse, Lyon, 69004, France.
Eur J Pediatr. 2023 Mar;182(3):1143-1154. doi: 10.1007/s00431-022-04775-3. Epub 2023 Jan 4.
This cohort study aimed to evaluate the impact of an individualised nutritional care approach combining standardised fortification with adjustable fortification on postnatal growth and body composition in extremely low birth weight (ELBW) infants. We included ELBW infants admitted to a neonatal intensive care unit and still hospitalised at 35 weeks postmenstrual age (PMA). The fortification of human milk was standardised (multicomponent fortifier) between 70 mL/kg/day and full enteral feeding, and then individualised using adjustable fortification. When weight gain was below 20 g/kg/day, protein or energy was added when serum urea was below or above 3.5 mmol/L, respectively. Postnatal growth failure (PNGF) was defined as being small for gestational age at discharge and/or when the Z-score loss between birth and discharge was higher than 1. Body composition was assessed between 35 and 41 weeks of PMA. Among the 310 ELBW infants included, the gestational age of birth was 26.7 ± 1.8 weeks, and the birth weight was 800 ± 128 g. The mean Z-score difference between birth and discharge was moderately negative for the weight (-0.32), more strongly negative for length (-1.21), and almost nil for head circumference (+ 0.03). Only 27% of infants presented PNGF. At discharge, fat mass was 19.8 ± 3.6%. Multivariable analysis showed that the proportion of preterm formula received and gestational age at birth were independently associated with the percentage of fat mass. Conclusion: The individualised nutritional care approach applied herein prevented postnatal weight loss in most infants, limited length growth deficit, and supported excellent head circumference growth. What is Known: • At least half of extremely low birth weight infants are small for gestational age at discharge and postnatal growth deficit has been associated with impaired neurocognitive and renal development. • Human milk is the main milk used in neonatology and, although fortification of human milk is a standard of care, there is no consensus regarding the optimal fortification strategy to be adopted. What is New: • Using an approach combining standardised fortification followed by individualised adjustable fortification limited postnatal growth deficit for body weight and head circumference. Postnatal growth failure is not a fatality in extremely low birth weight infants. • Each additional gestational age week at birth resulted in a decrease in fat mass percentage at discharge, which was higher than in foetuses of the same gestational age, likely representing a necessary adaptation to extra-uterine life.
这项队列研究旨在评估个体化营养护理方法对极低出生体重（ELBW）婴儿的产后生长和身体成分的影响，该方法将标准化强化与可调节强化相结合。我们纳入了在新生儿重症监护病房住院且在 35 周校正胎龄时仍住院的 ELBW 婴儿。人乳强化在 70ml/kg/天至全肠内喂养之间标准化（多组分强化剂），然后使用可调节强化进行个体化。当体重增加低于 20g/kg/天时，当血清尿素低于或高于 3.5mmol/L 时，分别添加蛋白质或能量。出院时体重与胎龄不匹配且/或出生至出院时 Z 评分丢失大于 1 定义为生长发育迟缓。在 35 至 41 周校正胎龄之间评估身体成分。在纳入的 310 名 ELBW 婴儿中，出生胎龄为 26.7±1.8 周，出生体重为 800±128g。出生至出院时体重 Z 评分差值为中度负值（-0.32），长度 Z 评分差值更明显（-1.21），头围 Z 评分差值几乎为零（+0.03）。只有 27%的婴儿出现生长发育迟缓。出院时，脂肪量为 19.8±3.6%。多变量分析显示，接受早产儿配方奶的比例和出生胎龄与脂肪量百分比独立相关。结论：本研究中应用的个体化营养护理方法防止了大多数婴儿的体重丢失，限制了身长生长缺陷，并支持了极好的头围生长。已知内容：• 至少一半的极低出生体重儿在出院时体重与胎龄不匹配，且出生后生长不良与神经认知和肾脏发育受损有关。• 人乳是新生儿科中使用的主要乳，尽管人乳强化是一种护理标准，但对于要采用的最佳强化策略尚无共识。新内容：• 使用结合标准化强化和个体化可调节强化的方法，限制了体重和头围的产后生长不良。极低出生体重儿的生长发育迟缓不是致命的。• 出生时每增加一周胎龄，出院时脂肪量百分比就会降低，这高于同胎龄胎儿的脂肪量百分比，这可能代表了对宫外生活的必要适应。
