We have just published a new article : The first author Marianne Lapointe is our senior NNP who has been heavily involved in improving nutritional standards in our NICU. She was a leader in developing our enhanced enteral feeding protocols, in installing them in actual practice, and in performing this research project. Félicitations Marianne. Also to Melissa Savaria who is an RN and lactation consultant in our NICU, who has worked diligently with mothers to maintain and improve our high breast-feeding rates. as for the two other authors, you will recognize their names.
I have mentioned the study before, it is a comparison of 2 historical cohorts, before and after we changed our nutritional protocols. This is the abstract:
There were 153 infants in cohort 1 and 118 in cohort 2. 19% were growth restricted at birth in both cohorts. Feeds advanced more quickly in cohort 2, with decreased duration of central lines and TPN; breast milk fortification occurred sooner. Calorie and protein intakes were increased during all of the first 14 days of life. Adverse clinical outcomes were unchanged, including NEC. The proportion of infants discharged < 10th percentile of expected weight, decreased from 23% to 9%. In cohort 2, the z-score for body weight decreased by 0.39, compared to an average 1.03 in cohort 1 (p<0.001). Head circumference and body weight were also significantly improved at discharge (p<0.01), but length was improved to a lesser degree.
Early and enhanced postnatal intravenous and enteral feeding can provide good postnatal growth among very immature infants without adverse effects. Calorie and, particularly, protein intake in early life could probably be further optimized
What can we do better? There is now reasonably good evidence that we should be targeting 4 g/kg/day of protein intake in the small preterm. This should improve linear growth, and hopefully normalize body composition. Our latest update of the nutrition protocol increases protein by aiming for higher volumes of breast milk with standard fortification, or increased fortification if the volume is not tolerated.
Another observational study supports the need to reduce and prevent post-natal growth restriction Pampanini V, et al. Preterm infants with severe extrauterine growth retardation (EUGR) are at high risk of growth impairment during childhood. Eur J Pediatr. 2015;174(1):33-41. The title basically says it all, as a good title should (you should still read the article to see if the title is accurate!)