Susanna Klevebro1, Vera Westin2, Elisabeth Stoltz Sjöström3, Mikael Norman4, Magnus Domellöf5, Anna-Karin Edstedt Bonamy6, Boubou Hallberg4. 1. Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden; Sachs' Children and Youth Hospital, South General Hospital, Stockholm, Sweden. Electronic address: susanna.klevebro@ki.se. 2. Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden; Function Area Clinical Nutrition, Karolinska University Hospital, Stockholm, Sweden. 3. Department of Food and Nutrition, Umeå University, Umeå, Sweden. 4. Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden; Department of Neonatal Medicine, Karolinska University Hospital, Stockholm, Sweden. 5. Department of Clinical Sciences, Pediatrics, Umeå University, Umeå, Sweden. 6. Sachs' Children and Youth Hospital, South General Hospital, Stockholm, Sweden; Department of Women's and Children's Health and Clinical Epidemiology Unit, Karolinska Institutet, Stockholm, Sweden.
Abstract
BACKGROUND & AIM: Extremely preterm infants face substantial neonatal morbidity. Nutrition is important to promote optimal growth and organ development in order to reduce late neonatal complications. The aim of this study was to examine the associations of early nutritional intakes on growth and risks of bronchopulmonary dysplasia (BPD) and retinopathy of prematurity (ROP) in a high-risk population. METHODS: This population-based cohort study includes infants born before 27 0/7 weeks of gestational age without severe malformations and surviving ≥10 days. Intake of energy and protein on postnatal days 4-6 and association with weight standard deviation score (WSDS) from birth to day 7, as well as intakes of energy and protein on postnatal days 4-6 and 7 to 27, respectively, and association with composite outcome of death and BPD and separate outcomes of BPD and ROP were examined, and adjusted for potential confounders. RESULTS: The cohort comprised 296 infants with a median gestational age of 25 3/7 weeks. Expressed as daily intakes, every additional 10 kcal/kg/d of energy during days 4-6 was associated with 0.08 higher WSDS on day 7 (95% CI 0.06-0.11; p < 0.001). Between days 7 and 27, every 10 kcal/kg/d increase in energy intake was associated with a reduced risk of BPD of 9% (95% CI 1-16; p = 0.029) and any grade of ROP with a reduced risk of 6% (95% CI 2-9; p = 0.005) in multivariable models. This association was statistically significant in infants with ≤10 days of mechanical ventilation. In infants with >10 days of mechanical ventilation, a combined higher intake of energy and protein was associated with a reduced risk of BPD. CONCLUSION: Early provision of energy and protein may reduce postnatal weight loss and risk of morbidity in extremely preterm infants.
BACKGROUND & AIM: Extremely preterm infants face substantial neonatal morbidity. Nutrition is important to promote optimal growth and organ development in order to reduce late neonatal complications. The aim of this study was to examine the associations of early nutritional intakes on growth and risks of bronchopulmonary dysplasia (BPD) and retinopathy of prematurity (ROP) in a high-risk population. METHODS: This population-based cohort study includes infants born before 27 0/7 weeks of gestational age without severe malformations and surviving ≥10 days. Intake of energy and protein on postnatal days 4-6 and association with weight standard deviation score (WSDS) from birth to day 7, as well as intakes of energy and protein on postnatal days 4-6 and 7 to 27, respectively, and association with composite outcome of death and BPD and separate outcomes of BPD and ROP were examined, and adjusted for potential confounders. RESULTS: The cohort comprised 296 infants with a median gestational age of 25 3/7 weeks. Expressed as daily intakes, every additional 10 kcal/kg/d of energy during days 4-6 was associated with 0.08 higher WSDS on day 7 (95% CI 0.06-0.11; p < 0.001). Between days 7 and 27, every 10 kcal/kg/d increase in energy intake was associated with a reduced risk of BPD of 9% (95% CI 1-16; p = 0.029) and any grade of ROP with a reduced risk of 6% (95% CI 2-9; p = 0.005) in multivariable models. This association was statistically significant in infants with ≤10 days of mechanical ventilation. In infants with >10 days of mechanical ventilation, a combined higher intake of energy and protein was associated with a reduced risk of BPD. CONCLUSION: Early provision of energy and protein may reduce postnatal weight loss and risk of morbidity in extremely preterm infants.
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