Background: Extremely preterm birth is associated with a high risk of extrauterine growth retardation, which has been linked with adverse developmental outcomes. Objective: We investigated whether nutritional management during the first 7 days of life affects growth patterns until the corrected age of 2 years in extremely preterm infants. Study Design: A retrospective study of 78 extremely preterm (<28 weeks' gestation) neonates was conducted. Data regarding parenteral and enteral intake of energy, protein, lipids, and carbohydrates during the first 7 days of life were collected from patient records. The outcome measures included weight, height, and head circumference with Z scores at term-equivalent age and the corrected ages of 1 and 2 years. Analyses were performed with hierarchical-linear mixed models. Results: Nutritional intake during the first week of life did not reach the current recommendations. The total energy intake during the first 7 days of life was statistically significantly associated with weight, length, and head circumference until the corrected age of 2 years after adjusting for potential confounding factors. Individual macronutrient intake displayed no association with growth patterns. Conclusions: Energy intake during the first 7 days of life is associated with growth until the corrected age of 2 years. These results provide support for the aggressive early nutritional management of extremely preterm infants.

1.
Horbar JD, Ehrenkranz RA, Badger GJ, Edwards EM, Morrow KA, Soll RF, et al: Weight growth velocity and postnatal growth failure in infants 501 to 1,500 g: 2000-2013. Pediatrics 2015;136:e84-e92.
2.
Fanaroff AA, Stoll BJ, Wright LL, Carlo WA, Ehrenkranz RA, Stark AR, et al: Trends in neonatal morbidity and mortality for very low birthweight infants. Am J Obstet Gynecol 2007, DOI: 10.1016/j.ajog.2006.09.014.
3.
Ehrenkranz RA, Dusick AM, Vohr BR, Wright LL, Wrage LA, Kenneth Poole W: Growth in the neonatal intensive care unit influences neurodevelopmental and growth outcomes of extremely low birth weight infants. Pediatrics 2006;117:1253-1261.
4.
Cleminson JS, Zalewski SP, Embleton ND: Nutrition in the preterm infant. Curr Opin Clin Nutr Metab Care 2016;19:1.
5.
Koletzko B, Goulet O, Hunt J, Krohn K, Shamir R: 1. Guidelines on Paediatric Parenteral Nutrition of the European Society of Paediatric Gastroenterology , Hepatology and Nutrition ( ESPGHAN ) and the European Society for Clinical Nutrition and Metabolism ( ESPEN ), Supported by the European Society of Paediatric Gastroenterology. J Pediatr Gastroenterol Nutr 2005;3336:1-4.
6.
McNelis K, Fu TT, Poindexter B: Nutrition for the extremely preterm infant. Clin Perinatol 2017;44:395-406.
7.
Stephens BE, Walden RV, Gargus RA, Tucker R, Mance M, Nye J, et al: First-Week Protein and Energy Intakes Are Associated With 18-Month Developmental Outcomes in Extremely Low Birth Weight Infants. Pediatrics 2009;123:1337-1343.
8.
Dinerstein A, Nieto R, Solana C, Perez G, Otheguy L, Larguia A: Early and aggressive nutritional strategy (parenteral and enteral) decreases postnatal growth failure in very low birth weight infants. J Perinatol 2006;26:436-442.
9.
Maas C, Franz AR, Krogh S von, Arand J, Poets CF: Growth and morbidity of extremely preterm infants after early full enteral nutrition. Arch Dis Child Fetal Neonatal Ed 2017, E-pub ahead of print.
10.
Cormack BE, Embleton ND, van Goudoever JB, Hay WWJ Jr: Comparing apples with apples: it is time for standardized reporting of neonatal nutrition and growth studies. Pediatr Res 2016, DOI: 10.1038/pr.2016.26.
11.
Saari A, Sankilampi U, Hannila M-L, Kiviniemi V, Kesseli K, Dunkel L: New Finnish growth references for children and adolescents aged 0 to 20 years: length/height-for-age, weight-for-length/height, and body mass index-for-age. Ann Med 2011;43:235-248.
12.
Berry MA, Abrahamowicz M, Usher RH: Factors associated with growth of extremely premature infants during initial hospitalization. Pediatrics 1997;100:640-646.
13.
Matinolli H-M, Hovi P, Männistö S, Sipola-Leppänen M, Eriksson JG, Mäkitie O, et al: Early protein intake is associated with body composition and resting energy expenditure in young adults born with very low birth weight. J Nutr 2015;145:2084-2091.
14.
Maggio L, Cota F, Gallini F, Lauriola V, Zecca C: Effects of high versus standard early protein intake on growth of extremely low birth weight infants. J Pediatr Gastroenterol Nutr 2007;44:124-129.
15.
Cormack BE, Bloomfield FH: Increased protein intake decreases postnatal growth faltering in ELBW babies. Arch Dis Child Fetal Neonatal Ed 2013;98:F399-F404.
16.
Bellagamba MP, Carmenati E, D'Ascenzo R, Malatesta M, Spagnoli C, Biagetti C, et al: One extra gram of protein to preterm infants from birth to 1,800 g. J Pediatr Gastroenterol Nutr 2016;62:879-884.
17.
Vlaardingerbroek H, Vermeulen MJ, Carnielli VP, Vaz FM, van den Akker CHP, van Goudoever JB: Growth and fatty acid profiles of VLBW infants receiving a multicomponent lipid emulsion from birth. J Pediatr Gastroenterol Nutr 2014;58:417-427.
18.
Roelants JA, Vlaardingerbroek H, van den Akker CHP, de Jonge RCJ, van Goudoever JB, Vermeulen MJ: Two-year follow-up of a randomized controlled nutrition intervention trial in very low-birth-weight infants. JPEN J Parenter Enteral Nutr 2016, DOI: 10.1177/0148607116678196.
19.
Uthaya S, Liu X, Babalis D, Dore C, Warwick J, Bell J, et al: Nutritional Evaluation and Optimisation in Neonates (NEON) trial of amino acid regimen and intravenous lipid composition in preterm parenteral nutrition: a randomised double-blind controlled trial. Effic Mech Eval 2016;3:1-80.
20.
Van Den Akker CHP, Te Braake FWJ, Weisglas-Kuperus N, Van Goudoever JB: Observational outcome results following a randomized controlled trial of early amino acid administration in preterm infants. J Pediatr Gastroenterol Nutr 2014;59:714-719.
21.
Uthaya S, Modi N: Practical preterm parenteral nutrition: systematic literature review and recommendations for practice. Early Hum Dev 2014;90:747-753.
22.
Embleton ND, Simmer K: Practice of parenteral nutrition in VLBW and ELBW infants. World Rev Nutr Diet 2014;110:177-189.
23.
Clayton PE, Cianfarani S, Czernichow P, Johannsson G, Rapaport R, Rogol AD: Consensus statement: management of the child born small for gestational age through to adulthood. A consensus statement of the International Societies of Pediatric Endocrinology and the Growth Hormone Research Society. J Clin Endocrinol Metab 2007;92:804-810.
24.
Kramer MS, Zhang X, Dahhou M, Yang S, Martin RM, Oken E, et al: Does fetal growth restriction cause later obesity? Pitfalls in analyzing causal mediators as confounders. Am J Epidemiol 2017;185:585-590.
25.
Kramer MS, Martin RM, Bogdanovich N, Vilchuk K, Dahhou M, Oken E: Is restricted fetal growth associated with later adiposity ? Observational analysis of a randomized trial. Am J Clin Nutr 2014;100:176-181.
26.
Sipola-Leppanen M, Kajantie E: Should we assess cardiovascular risk in young adults born preterm? Curr Opin Lipidol 2015;26:282-287.
27.
Mitanchez D, Charkaluk M, Fresson J, Arnaud C: Effect of intra- and extrauterine growth on long-term neurologic outcomes of very preterm infants. J Pediatr 2016;175:93-99.
28.
Leppänen M, Lapinleimu H, Lind A, Matomäki J, Lehtonen L, Haataja L, et al: Antenatal and postnatal growth and 5-year cognitive outcome in very preterm infants. Pediatrics 2014;133:63-70.
29.
Harding JE, Cormack BE, Alexander T, Alsweiler JM, Bloomfield FH: Advances in nutrition of the newborn infant. Lancet 2017;389:1660-1668.
30.
Su BH: Optimizing nutrition in preterm infants. Pediatr Neonatol 2014;55:5-13.
31.
Beauport L, Schneider J, Faouzi M, Hagmann P, Hüppi PS, Tolsa J-F, et al: Impact of early nutritional intake on preterm brain: a magnetic resonance imaging study. J Pediatr 2016;181:29-36.e1.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.