Optimizing the growth of very-low-birth-weight infants requires targeting both nutritional and nonnutritional modifiable factors specific to stage of hospitalization Academic Article uri icon

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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.

authors

  • Asbury, Michelle R
  • Unger, Sharon
  • Kiss, Alex
  • Ng, Dawn VY
  • Luk, Yunnie
  • Bando, Nicole
  • Bishara, Rosine
  • Tomlinson, Christopher
  • O'Connor, Deborah L
  • 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, Eu-gene
  • 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

publication date

  • December 1, 2019