Influence of morbidity, early nutritional intake, and total energy: protein ratio on longitudinal extrauterine growth restriction of very preterm newborns at term-equivalent age: an observational study.

To evaluate the influence of early nutritional intake on the growth pattern of very preterm infants. This was an observational study including 109 newborns (< 32 weeks gestational age). Perinatal morbidities, nutritional therapy (first four weeks of life), and weight, length, and head circumference (HC) growth at term-equivalent age were evaluated. Growth restriction was defined as a difference > 1.2 SD between the birth and term age measurements. Growth restriction at term-equivalent age: 52.3% (weight), 42.9% (length), and 22% (HC). Morbidities were positively correlated with nutrition therapy and negatively correlated with the total energy provision: protein ratio. The duration of parenteral nutrition, the time to reach full enteral feedings, and the total energy provision: protein ratio were significantly correlated. Nutrient intake influenced weight, length, and HC growth, and cumulative energy deficit was significantly associated with HC growth restriction.   Conclusion: Perinatal morbidities interfere with nutritional therapy and early nutrient intake, leading to insufficient energy and energy provision: protein ratio for growth. What is Known: • The intake of macronutrients early in life, mainly protein, is important for the optimal growth of pretem infants. • The severity of morbidities and low gestational ages impact the nutritional management of preterm infants. What is New: • The number of morbidities, reflecting the severity of the neonatal clinical course, had a detrimental effect on the nutritional therapy and nutrients intake. • The inadequate energy provision per gram of protein ratio was significantly associated with growth restriction in all growth measures at the second week of life, persisting for head circumference up to the fourth week, highlighting the importance of its measurement, as it could be a precocious sign of development risk.

Resting energy expenditure in preterm newborns with bronchopulmonary dysplasia.

BACKGROUND & AIMS: Greater energy expenditure is reported in newborns with bronchopulmonary dysplasia (BPD). This study assessed resting energy expenditure (REE) in newborns with BPD. METHODS: BPD was classified as mild and moderate/severe. REE was assessed using indirect calorimetry between the time points of the discontinuation of oxygen (O2) (T1) and at term-equivalent age (T2) in preterm newborns with BPD. RESULTS: The moderate group (10 newborns) presented with higher REE (kcal/kg/day) after discontinuation of mechanical ventilation and a decrease of 18% between the two time points; 72.7 and 59.6 kcal/kg/day at T1 and T2 respectively (p value 0.08). No differences were observed in REE in the mild BPD group between timepoints; 50.9-56.4 kcal/kg/day at T1 and T2 respectively (p value 0.73). CONCLUSION: Newborns with BPD presented different metabolic behaviors depending on the classification criteria: those classified as having moderate BPD showed a decrease in REE toward term-equivalent age.

Energy expenditure and body composition in infants with bronchopulmonary dysplasia at term age.

In this cross-sectional study, conducted in a cohort of infants with a gestational age of < 32 weeks, we aimed to evaluate and compare resting energy expenditure (REE) and body composition between infants who developed bronchopulmonary dysplasia (BPD) and those who did not. REE and body composition were assessed at term equivalent age using indirect calorimetry and air displacement plethysmography. Anthropometric measurements (weight, head circumference, and length) were obtained and transformed into Z-scores per the Fenton (2013) growth curve, at birth and at term equivalent age. Forty-two infants were included in this study, of which 26.2% developed BPD. Infants with BPD had significantly higher energy expenditure at term equivalent age, with no difference in body composition between the two groups. CONCLUSION: Despite expending more energy, infants with BPD maintained a similar body composition distribution to those without BPD, and this is likely due to the recommended nutritional approach. WHAT IS KNOWN: • Greater resting energy expenditure impairs growth of preterm infants with bronchopulmonary dysplasia. WHAT IS NEW: • Although preterm infants with bronchopulmonary dysplasia had a higher resting energy expenditure at the corrected term age, this did not affect their body composition and growth.

Avaliação do gasto metabólico, crescimento e composição coporal em recém-nascidos pré-termos com displasia broncopulmonar / Evaluation of metabolic expenditure, growth and body composition in preterm newborns with bronchopulmonary dysplasia

Os recém-nascidos pré-termos, principalmente os de extremo baixo peso, com os avanços tecnológicos estão sobrevivendo mais e garantir uma nutrição adequada é um dos grandes desafios da neonatologia. As morbidades encontradas, entre as quais a displasia broncopulmonar, contribuem de forma determinante no manejo hídrico e nutricional desta população. A displasia broncopulmonar (DBP) é uma das morbidades mais frequentes em recém-nascidos pré-termos, e com os avanços médicos, as técnicas menos agressivas de suporte ventilatório, o uso de corticosteroides antenatais e surfactante, a tendência é uma diminuição na sua incidência, o que não ocorreu na população de pré-termos extremos, devido à maior sobrevida desta população. A restrição do crescimento após o nascimento neste grupo de recém-nascidos com DBP decorre de diversos fatores: o maior gasto energético devido ao aumento do trabalho respiratório, a inflamação e o reparo tissular e a diminuição da ingesta alimentar, dificultando a oferta de um aporte nutricional adequado. A nutrição tem efeito direto sobre a maturação pulmonar e, portanto, a oferta insuficiente de nutrientes pode exacerbar os danos alveolares. O conhecimento do gasto energético de repouso pode auxiliar na programação da oferta de energia diária. Estudos com calorimetria indireta têm sido utilizados para verificar o gasto energético dos recém-nascidos. É importante, portanto, estudar o gasto metabólico e avaliar o seu impacto no crescimento pondero estatural e na composição corporal de recém-nascidos pré-termo com DBP, considerando as mudanças terapêuticas ocorridas. Os objetivos deste estudo foram: (i) avaliar o gasto metabólico, a composição corporal, e o crescimento pondero- estatural de recém-nascidos com e sem DBP na idade corrigida de termo; (ii) analisar a associação entre o gasto metabólico, a composição corporal e o crescimento (escores Z de peso, comprimento e perímetro cefálico) na idade corrigida de termo. Foram incluídos no estudo recém-nascidos com idade gestacional < 32 semanas, admitidos na Unidade de Terapia Intensiva Neonatal do Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira; foi considerada como exposição o desenvolvimento de DBP. A DBP foi definida pela necessidade de oxigênio às 36 semanas de idade corrigida. Foram excluídos do estudo recém-nascidos com malformações congênitas, síndromes vii genéticas, hidropisia fetal, infecções congênitas comprovadas e aqueles que estavam em suporte ventilatório no momento da avaliação do gasto energético. Para a avaliação do aporte nutricional foram registradas as quantidades de proteínas, lipídios, carboidratos e calorias efetivamente recebidas diariamente nas primeiras quatro semanas de vida e no momento de cada avaliação na idade corrigida de termo. Foram registradas informações gestacionais e perinatais. No momento de avaliação foi registrado o tipo de alimentação: leite materno exclusivo, leite materno complementado com fórmula, fórmula exclusiva ou fórmula especial. No caso dos recém-nascidos com DBP, foi registrada a terapia específica prescrita: diuréticos, corticoide, broncodilatadores. O gasto metabólico foi avaliado pela calorimetria indireta (Deltratac II Metabolic Monitor), realizada na idade corrigida de termo nos recém- nascidos com e sem DBP. Foi realizada avaliação antropométrica (peso, comprimento e perímetro cefálico) ao nascimento e na idade corrigida de termo. A composição corporal foi avaliada através da pletismografia por deslocamento de ar (PEA POD Infant Body Composition System) nos recém-nascidos com e sem DBP na idade corrigida de termo. Foram realizadas análises descritivas para estimar frequências, identificar padrões e analisar discrepâncias de dados. As variáveis contínuas foram expressas em média (DP), e asfrequências das variáveis categóricasforam expressas em porcentagens (%). O gasto energético de repouso, o volume do consumo de oxigênio, o volume do gás carbônico produzido, a porcentagem e o volume de massa livre de gordura, porcentagem e volume de massa gorda, as medidas antropométricas com osrespectivos escores Z na idade gestacional corrigida de termo foram comparados entre os recém-nascidos pré-termos com e sem DBP. Apesar de observamos maior gasto energético de repouso nos recém-nascidos com DBP na idade corrigida de termo, não se refletiu na composição corporal e no crescimento. Não observamos diferenças significativas na composição corporal e no crescimento entre os recém-nascidos com e sem DBP.

The technological advances in neonatology are resulting in a greater survival of preterm newborns, especially those with extremely low birth weight, and one of the great challenges of neonatology is to ensure an adequate nutrition for these newborns. Neonatal morbidities, including bronchopulmonary dysplasia, contribute decisively to the fluids and nutritional management of this population. Bronchopulmonary dysplasia (BPD) is one of the most frequent morbidities in preterm newborns, and with medical advances, less aggressive techniques of mechanical ventilation, the use of antenatal corticosteroids and surfactant, the tendency is for a decrease in its incidence; nevertheless, this did not occur in the extremely preterm population, due to the greater survival of this population. The growth restriction after birth in the BPD newborns group is due to several factors: the greater energy expenditure due to the increase in respiratory work, inflammation and tissue repair, and the decrease in food intake, making the offer of an adequate nutrition difficult. Nutrition has a direct effect on lung maturation and, therefore, insufficient nutrient supply can exacerbate alveolar damage. The knowledge of resting energy expenditure can improve the daily energy supply programming. Studies with indirect calorimetry have been used to verify the energy expenditure of newborns. Therefore, it is important to study the metabolic expenditure and assess its impact on growth and body composition of preterm newborns with BPD, considering the therapeutic changes that have occurred. The objectives of this study were: (i) to assess metabolic expenditure, body composition, and growth of newborns with and without BPD at term equivalent age; (ii) to analyze the association between metabolic expenditure, body composition and growth (weight, length and head circumference Z scores) at term equivalent age. Newborns with gestational age < 32 weeks, admitted to the Neonatal Intensive Care Unit of the National Institute of Women's, Children's and Adolescent´s Health Fernandes Figueira, were included in the study; the exposure considered was the development of BPD. BPD was defined by the need for oxygen at 36 weeks of corrected gestational age. The exclusion criteria were newborns with congenital malformations, genetic syndromes, hydrops fetalis, proven congenital infections, and those who were on ventilatory support at the time of the ix energy expenditure assessment. For the assessment of the nutritional intake, the daily quantities of proteins, lipids, carbohydrates, and calories effectively received in the first four weeks of life, and at the time of each assessment at term equivalent age were recorded. Gestational and perinatal information were recorded. The type of feeding was recorded at the assessment moments: exclusive breastfeeding, breast milk supplemented with formula, exclusive formula or special formula. In the case of newborns with BPD, the specific therapy prescribed was recorded: diuretics, corticosteroids, bronchodilators. Metabolic expenditure was assessed by indirect calorimetry (Deltratac II Metabolic Monitor), performed at term equivalent age in newborns with and without BPD. Anthropometric assessment (weight, length and head circumference) was performed at birth and at term equivalent age. Body composition was assessed using air displacement plethysmography (PEA POD Infant Body Composition System) in newborns with and without BPD at term equivalent age. Descriptive analyzes were performed to estimate frequencies, identify patterns and analyze data discrepancies. Continuous variables were expressed as mean (SD), and frequencies of categorical variables were expressed as percentages (%). Resting energy expenditure, volume of oxygen consumption, volume of carbon dioxide produced, percentage and volume of fat-free mass, percentage and volume of fat mass, anthropometric measurements with the respective Z-scores at term equivalent age were compared between preterm infants with and without BPD. Although we observed higher resting energy expenditure in newborns with BPD at term corrected age, this was not reflected in body composition and growth. We did not observe significant differences in body composition and growth between newborns with and without BPD.

Growth and body composition in preterm newborns with bronchopulmonary dysplasia: a cohort study.

Objective To compare growth and body composition of preterm infants (gestational age <32 weeks) with and without bronchopulmonary dysplasia (BPD). Methods A prospective cohort involving three neonatal units in the public health system of the Brazilian city of Rio de Janeiro. Inclusion: newborns with gestational age <32 weeks. EXPOSURE: BPD. Anthropometric measurements were performed at birth and at 1 month of infant corrected age. Body composition was measured using an air displacement plethysmography (ADP) (PEA POD®) at 1 month of infant corrected age. Results Ninety-five newborns were eligible, of which 67 were included, 32.8% of them with BPD. Newborns with BPD presented lower gestational age at birth, greater need for resuscitation in the delivery room, received parenteral nutrition (PN) for a longer period of time, achieved lower weights during hospital stay and required more time to reach a full enteral diet. No statistically significant differences were observed in relation to anthropometric measurements and body composition at 1 month of infant corrected age between the groups with and without BPD. Conclusion This study, unlike previous ones, has shown that children who developed BPD were able to regain growth, as measured by anthropometric measures, with no change in body composition at 1 month of infant corrected age.

Variables associated with extra uterine growth restriction in very low birth weight infants / Fatores associados à restrição de crescimento extrauterino em recém-nascidos pré-termos de muito baixo peso ao nascer

OBJECTIVES: To determine the rate of extrauterine growth restriction in very low birth weight infants and to evaluate the influence of perinatal variables, clinical practices, and neonatal morbidities on this outcome. METHODS: A longitudinal study was performed in four neonatal units in the city of Rio de Janeiro. 570 very low birth weight infants were analyzed. The study included perinatal variables, variables related to clinical practices, and incident morbidities in these preterm infants. Extrauterine growth restriction was defined using z-scores for weight or head circumference < -2 for cor-rected age. Statistical analysis was performed using the Statistical Package for Social Sciences (SPSS) and R software. RESULTS: This study comprised 570 infants, of which 49% were males, and 33% were small for gestational age (SGA). The mean weight and head circumference at birth were 1,113 ± 267 g and 27 ± 2 cm, respectively. The mean z-scores of birth weight and weight at discharge were -0.96± 0.78 and -1.54 ± 0.75, respectively; for head circumference, the mean z-scores at birth and at discharge were -0.63 ± 1.18 and -0.45 ± 0.94, respectively. The rate of extrauterine growth restriction considering the weight was 26% (149/570) and considering the head circumference, 5% (29/570). SGA was the variable with the greatest impact on both growth restriction for weight (PR = 4.33) and for head circumference (PR = 2.11) in adjusted analyses. CONCLUSION: Extrauterine growth restriction was high in the population, especially for SGA newborns and those with neonatal morbidities .

OBJETIVOS: Determinar a frequência da restrição de crescimento extrauterino em recém-nascidos prétermos de muito baixo peso e avaliar o impacto de variáveis perinatais, práticas clínicas e morbidades neonatais nesta morbidade. MATERIAIS E MÉTODOS: Foi realizado um estudo longitudinal em 4 unidades neonatais do Rio de Janeiro. Foram analisados 570 recém-nascidos pré-termos de muito baixo peso. Foram incluídas no estudo variáveis perinatais, variáveis relacionadas às práticas clínicas e morbidades incidentes nestes recém-nascidos. A restrição de crescimento extrauterino foi definida pelos escores z de peso ou perímetro cefálico < -2 para idade corrigida. Na análise estatística foram utilizados o software SPSS e o software R. RESULTADOS: Foram analisados 570 recém-nascidos dos quais 49% eram do sexo masculino e 33% nasceram pequenos para idade gestacional. A média do peso e perímetro cefálico ao nascimento foi respectivamente 1113 ± 267 g e 27 ± 2 cm. As médias de escore z do peso ao nascimento e na alta foram respectivamente, -0,96 ± 0,78 e -1,54 ± 0,75 e as do perímetro cefálico foram -0,63± 1,18 e -0,45 ± 0,94. A frequência de restrição de crescimento extrauterino considerando o peso foi 26% do perímetro cefálico foi de 5%. Nascer pequeno para idade gestacional foi a variável de maior impacto na restrição de crescimento tanto para o peso (RP 4,33) quanto parao perímetro cefálico (RP 2,11) nas analises ajustadas. CONCLUSÃO: A restrição de crescimento extrauterino foi alta na população, especialmente para os recém-nascidos PIG e com morbidades neonatais. .

Variables associated with extra uterine growth restriction in very low birth weight infants.

OBJECTIVES: To determine the rate of extrauterine growth restriction in very low birth weight infants and to evaluate the influence of perinatal variables, clinical practices, and neonatal morbidities on this outcome. METHODS: A longitudinal study was performed in four neonatal units in the city of Rio de Janeiro. 570 very low birth weight infants were analyzed. The study included perinatal variables, variables related to clinical practices, and incident morbidities in these preterm infants. Extrauterine growth restriction was defined using z-scores for weight or head circumference ≤ -2 for corrected age. Statistical analysis was performed using the Statistical Package for Social Sciences (SPSS) and R software. RESULTS: This study comprised 570 infants, of which 49% were males, and 33% were small for gestational age (SGA). The mean weight and head circumference at birth were 1,113 ± 267 g and 27 ± 2 cm, respectively. The mean z-scores of birth weight and weight at discharge were -0.96 ± 0.78 and -1.54 ± 0.75, respectively; for head circumference, the mean z-scores at birth and at discharge were -0.63 ± 1.18 and -0.45 ± 0.94, respectively. The rate of extrauterine growth restriction considering the weight was 26% (149/570) and considering the head circumference, 5% (29/570). SGA was the variable with the greatest impact on both growth restriction for weight (PR = 4.33) and for head circumference (PR = 2.11) in adjusted analyses. CONCLUSION: extrauterine growth restriction was high in the population, especially for SGA newborns and those with neonatal morbidities.