Neonatology, Instituto Nacional da Mulher, da Criança e do Adolescente Fernandes Figueira, Oswaldo Cruz Foundation, FIOCRUZ, Av. Rui Barbosa, 716, Flamengo, Rio de Janeiro, RJ, Brasil, CEP 22250-020.
Postgraduation on Applied Clinical Research, Instituto Nacional da Mulher, da Criança e do Adolescente Fernandes Figueira, Oswaldo Cruz Foundation, FIOCRUZ, Av. Rui Barbosa, 716, Flamengo, Rio de Janeiro, RJ, Brasil, CEP 22250-020.
Eur J Pediatr. 2024 Aug;183(8):3327-3336. doi: 10.1007/s00431-024-05595-3. Epub 2024 May 11.
To evaluate the influence of early nutritional intake on the growth pattern of very preterm infants. This was an observational study including 109 newborns (< 32 weeks gestational age). Perinatal morbidities, nutritional therapy (first four weeks of life), and weight, length, and head circumference (HC) growth at term-equivalent age were evaluated. Growth restriction was defined as a difference > 1.2 SD between the birth and term age measurements. Growth restriction at term-equivalent age: 52.3% (weight), 42.9% (length), and 22% (HC). Morbidities were positively correlated with nutrition therapy and negatively correlated with the total energy provision: protein ratio. The duration of parenteral nutrition, the time to reach full enteral feedings, and the total energy provision: protein ratio were significantly correlated. Nutrient intake influenced weight, length, and HC growth, and cumulative energy deficit was significantly associated with HC growth restriction. Conclusion: Perinatal morbidities interfere with nutritional therapy and early nutrient intake, leading to insufficient energy and energy provision: protein ratio for growth. What is Known: • The intake of macronutrients early in life, mainly protein, is important for the optimal growth of pretem infants. • The severity of morbidities and low gestational ages impact the nutritional management of preterm infants. What is New: • The number of morbidities, reflecting the severity of the neonatal clinical course, had a detrimental effect on the nutritional therapy and nutrients intake. • The inadequate energy provision per gram of protein ratio was significantly associated with growth restriction in all growth measures at the second week of life, persisting for head circumference up to the fourth week, highlighting the importance of its measurement, as it could be a precocious sign of development risk.
评估早期营养摄入对极早产儿生长模式的影响。本研究为观察性研究，共纳入 109 例（<32 周胎龄）新生儿。评估围产期并发症、营养治疗（生后 4 周内）及体重、身长和头围（HC）在矫正胎龄时的增长情况。生长受限定义为出生时与矫正胎龄测量值之间的差异>1.2SD。矫正胎龄时的生长受限率为：体重 52.3%，身长 42.9%，HC 22%。并发症与营养治疗呈正相关，与总能量供给：蛋白质比值呈负相关。肠外营养持续时间、达到全肠内喂养时间及总能量供给：蛋白质比值与生长受限显著相关。营养素摄入影响体重、身长和 HC 生长，累积能量不足与 HC 生长受限显著相关。结论：围产期并发症干扰营养治疗和早期营养摄入，导致能量和能量供给：蛋白质比值不足，影响生长。已知情况：•生命早期宏量营养素的摄入，主要是蛋白质，对早产儿的最佳生长非常重要。•并发症的严重程度和较低的胎龄会影响早产儿的营养管理。新发现：•反映新生儿临床病程严重程度的并发症数量对营养治疗和营养素摄入有不利影响。•每克蛋白质的能量供给不足与所有生长指标的生长受限显著相关，在矫正胎龄第 2 周时头围即出现受限，持续到第 4 周，突出了其测量的重要性，因为它可能是发育风险的早期迹象。
