Optimizing the growth of very-low-birth-weight infants requires targeting both nutritional and nonnutritional modifiable factors specific to stage of hospitalization
Author:
Asbury Michelle R12, Unger Sharon1345, Kiss Alex67, Ng Dawn V Y12, Luk Yunnie12, Bando Nicole2, Bishara Rosine8, Tomlinson Christopher1234, O'Connor Deborah L125, Brennan Joan, Daneman Alan, Francis Jane, Jory Michael, Ly Linh, Plaga Aneta, Rovet Joanne, Kelly Edmond, Kotsopoulos Kirsten, O'Brien Karel, Asztalos Elizabeth, Church Paige, Nash Andrea, Ng Eugene, Wong Sabrina, Ekserci Sue, Sit Shirley, Arts-Rodas Debby, AlMadani Mahmud, Gryn David, Singh Munesh, Fusch Christoph, Campbell Douglas, Popovic Jelena, Doctor Shaheen, Stone Debbie, Azzopardi Peter, Chang Karen, van Schaik Charmaine, Williams Carol, Asady Anwar, Bayliss Ann, Gabriele Sandra, Burkot Ilona, Gibson-Stoliar Judy, Vaz Simone,
Affiliation:
1. Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada 2. Translational Medicine Program, The Hospital for Sick Children, Toronto, Ontario, Canada 3. Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada 4. Division of Neonatology, The Hospital for Sick Children, Toronto, Ontario, Canada 5. Department of Pediatrics, Mount Sinai Health System, Toronto, Ontario, Canada 6. Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada 7. Evaluative and Clinical Sciences, Sunnybrook Research Institute, Toronto, Ontario, Canada 8. Women & Babies Program, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
Abstract
ABSTRACT
Background
Data on how baseline characteristics, acuity, morbidity, and nutrition work in combination to affect the growth of very-low-birth-weight (VLBW, <1500 g) infants are limited.
Objective
We aimed to determine factors associated with in-hospital weight, length, and head circumference (HC) trajectories of VLBW infants.
Methods
VLBW infants (n = 316) from the GTA-DoMINO trial were included. Linear mixed-effects models assessed relations of baseline characteristics, acuity (at birth, across hospitalization), major morbidities, and nutrition (enteral feeding type, macronutrient/energy intakes) with changes in anthropometrics over hospitalization (days 1–8, 9–29, 30–75).
Results
Specific factors and the strength of their associations with growth depended on in-hospital time interval. Small-for-gestational-age infants experienced weight gain (4.3 g · kg−1 · d−1; 95% CI: 2.0, 6.5 g · kg−1 · d−1) during days 1–8, versus weight loss (−4.6 g · kg−1 · d−1; 95% CI: −5.6, −3.7 g · kg−1 · d−1) among appropriate-for-gestational-age infants (P < 0.001). Positive-pressure ventilation (versus oxygen/room air) was associated with slower weight (−1.8 g · kg−1 · d−1) and HC (−0.25 cm/wk) gain during days 9–29 (P < 0.001). Morbidities were negatively associated with growth after days 1–8, with patent ductus arteriosus (PDA) showing negative associations with weight (−2.7 g · kg−1 · d−1), length (−0.11 cm/wk), and HC (−0.21 cm/wk) gain during days 9–29 (P < 0.001). Macronutrient/energy intakes were associated with weight across hospitalization (P ≤ 0.01), with greater weight gain (1.3–3.0 g · kg−1 · d−1) among infants achieving macronutrient/energy recommendations during days 9–29 and 30–75. Macronutrient/energy intakes were associated with HC during the first month (P = 0.013–0.003), with greater HC gain (0.07–0.12 cm/wk) among infants achieving protein, lipid, and energy recommendations during days 9–29.
Conclusions
Baseline characteristics, acuity, morbidity, and nutrition factors were independently associated with VLBW infant growth. A focus on achieving macronutrient/energy recommendations and improving nutrient delivery to PDA-diagnosed infants may yield improvements to their growth. This trial was registered at www.isrctn.com as ISRCTN35317141.
Funder
Canadian Institutes of Health Research Ontario Graduate Scholarship Peterborough KM Hunter Charitable Foundation Hilda and William Courtney Clayton Paediatric Research Fund
Publisher
Oxford University Press (OUP)
Subject
Nutrition and Dietetics,Medicine (miscellaneous)
Cited by
24 articles.
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